Recombinant polypeptides, compositions, and methods thereof

ABSTRACT

The present disclosure provides recombinant polypeptides, homodimeric and heterodimeric proteins comprising the recombinant polypeptides, nucleic acid molecules encoding the recombinant polypeptides, and vectors and host cells comprising the nucleic acid molecules. The present disclosure also provides compositions comprising the recombinant polypeptides and methods of making and using the recombinant polypeptides.

REFERENCE TO SEQUENCE LISTING SUBMITTED ELECTRONICALLY

The content of the electronically submitted sequence listing (Name: 3902.001PC01_SeqListing_ST25.txt, Size: 134,451 bytes; and Date of Creation: Dec. 21, 2017) submitted in this application is incorporated herein by reference in its entirety.

BACKGROUND

Bone is a highly rigid tissue that constitutes part of the vertebral skeleton with unique mechanical properties derived from its extensive matrix structure. Throughout the life of animals, bone tissue is continuously renewed.

Processes of bone formation and renewal are carried out by specialized cells. Osteogenesis (bone formation or growth of bone) is carried out by “osteoblasts” (bone-forming cells). Bone remodeling occurs through an interplay between the activities of bone-resorbing cells called “osteoclasts” and the bone-forming osteoblasts. Since these processes are carried out by specialized living cells, chemical (for example, pharmaceutical and/or hormonal), physical, and physicochemical alterations can affect the quality, quantity, and shaping of bone tissue.

A variety of growth factors (for example, PDGF) as well as cytokines are involved in bone formation processes. It is thus valuable to identify physiologically acceptable chemical agents (for example, hormones, pharmaceuticals, growth factors, and cytokines) that can induce the formation of bone at a predetermined site. However, for the chemical agents to be successfully used as therapeutic tools, several hurdles need to be overcome. One hurdle includes developing recombinant polypeptides that have osteoinductive activity. For example, osteoinductive activity in recombinant human platelet-derived growth factor-BB has not been demonstrated. Another hurdle is osteoinductive variability in chemical agents. For example, demineralized bone matrix (DBM) is a chemical agent that is an osteoinductive allograft derived from processed bone. An increasing number of DBM-based products are commercially available, but osteoinductive variability has been found across different products and among production lots for the same product. Thus, there is a need for chemical agents, such as recombinant polypeptides and associated compositions, that demonstrate consistent osteoinductive activity.

BRIEF SUMMARY

The present disclosure is directed to a recombinant polypeptide comprising: a first domain selected from the group consisting of SEQ ID NO: 35 and SEQ ID NO: 39; a second domain selected from the group consisting of SEQ ID NO: 47 and SEQ ID NO: 49; and a third domain selected from the group consisting of SEQ ID NO: 57 and SEQ ID NO: 61; wherein the first domain is fused to either C-terminal or N-terminal of the second domain, the third domain is fused to the second domain, the first domain or both of the first and the second domains, and wherein the recombinant polypeptide is capable of inducing alkaline phosphatase activity.

In certain embodiments, the first domain is located C-terminal to the second domain, the third domain is located N-terminal to the second domain, or the first domain is located N-terminal to the third domain.

In certain embodiments, the second domain of the recombinant polypeptide comprises an intramolecular disulfide bond between the twenty-third amino acid of the second domain and the twenty-seventh amino acid of the second domain.

In certain embodiments, the third domain of the recombinant polypeptide comprises a first amino acid sequence of PKACCVPTE (SEQ ID NO: 356) and a second amino acid sequence of GCGCR (SEQ ID NO: 357), wherein the third domain comprises two intramolecular disulfide bonds between the first and second amino acid sequences.

In certain embodiments, the recombinant polypeptide comprises a first intramolecular disulfide bond between the fourth amino acid of the first amino acid sequence and the second amino acid of the second amino acid sequence, and a second intramolecular disulfide bond between the fifth amino acid of the first amino acid sequence and the fourth amino acid of the second amino acid sequence.

In certain embodiments, the recombinant polypeptide comprises a first intramolecular disulfide bond between the fifth amino acid of the first amino acid sequence and the second amino acid of the second amino acid sequence, and a second intramolecular disulfide bond between the fourth amino acid of the first amino acid sequence and the fourth amino acid of the second amino acid sequence.

In certain embodiments, the recombinant polypeptide is selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 268, SEQ ID NO: 276, SEQ ID NO: 284, SEQ ID NO: 292, SEQ ID NO: 300, SEQ ID NO: 308, SEQ ID NO: 316, SEQ ID NO: 324, SEQ ID NO: 332, SEQ ID NO: 340, and SEQ ID NO: 348.

The present disclosure is directed to a homodimeric protein comprising two identical recombinant polypeptides of any of the above recombinant polypeptides, wherein the homodimeric protein comprises an intermolecular disulfide bond between the first domains of the two recombinant polypeptides.

In certain embodiments, the homodimeric protein comprises an intermolecular disulfide bond between the fifteenth amino acid in the first domain of one recombinant polypeptide and the fifteenth amino acid in the first domain of the other recombinant polypeptide.

In certain embodiments, the second domain of one or both of the recombinant polypeptides of the homodimeric protein comprises an intramolecular disulfide bond.

In certain embodiments, the third domain of each recombinant polypeptide of the homodimeric protein comprises a first amino acid sequence of PKACCVPTE (SEQ ID NO: 356) and a second amino acid sequence of GCGCR (SEQ ID NO: 357), and the homodimeric protein comprises two intermolecular disulfide bonds between the first amino acid sequence in the third domain of one recombinant polypeptide and the second amino acid sequence in the third domain of the other recombinant polypeptide. In certain embodiments, the homodimeric protein comprises a first intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the other recombinant polypeptide, and a second intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the other recombinant polypeptide. In certain embodiments, the homodimeric protein comprises a first intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the other recombinant polypeptide, and a second intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the other recombinant polypeptide.

In certain embodiments, the third domain of each recombinant polypeptide of the homodimeric protein comprises a first amino acid sequence of PKACCVPTE (SEQ ID NO: 356) and a second amino acid sequence of GCGCR (SEQ ID NO: 357), and the homodimeric protein comprises two intramolecular disulfide bonds between the first amino acid sequence in the third domain of one recombinant polypeptide and the second amino acid sequence in the third domain of the same recombinant polypeptide. In certain embodiments, the homodimeric protein comprises a first intramolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the same recombinant polypeptide, and a second intramolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the same recombinant polypeptide. In certain embodiments, the homodimeric protein comprises a first intramolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the same recombinant polypeptide, and a second intramolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the same recombinant polypeptide.

The present disclosure is directed to a heterodimeric protein comprising two different recombinant polypeptides of any of the above recombinant polypeptides, wherein the heterodimeric protein comprises an intermolecular disulfide bond between the first domains of the two different recombinant polypeptides.

In certain embodiments, the heterodimeric protein comprises an intermolecular disulfide bond between the fifteenth amino acid in the first domain of one recombinant polypeptide and the fifteenth amino acid in the first domain of the other recombinant polypeptide.

In certain embodiments, the second domain of one or both of the two different recombinant polypeptides of the heterodimeric protein comprises an intramolecular disulfide bond.

The present disclosure is directed to a recombinant polypeptide comprising an amino acid sequence selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 268, SEQ ID NO: 276, SEQ ID NO: 284, SEQ ID NO: 292, SEQ ID NO: 300, SEQ ID NO: 308, SEQ ID NO: 316, SEQ ID NO: 324, SEQ ID NO: 332, SEQ ID NO: 340, and SEQ ID NO: 348, wherein the recombinant polypeptide is capable of inducing alkaline phosphatase activity.

The present disclosure is directed to a composition comprising any of the above recombinant polypeptides, any of the above homodimeric proteins, or any of the above heterodimeric proteins.

The present disclosure related to a sustained release composition comprising a calcium phosphate carrier, selected from the group consisting of tricalcium phosphate (TCP), alpha-tricalcium phosphate (α-TCP), beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP) and mixture thereof; and a biodegradable matrix, selected from the group consisting of polylactic acid (PLA), polyglycolic acid (PGA), polylactic-co-glycolic acid (PLGA), Polyvinyl alcohol (PVA) and mixture thereof; and a homodimeric protein as previous mentioned. Furthermore, the sustained release composition comprises (a) about 2-11% (w/w) of the calcium phosphate carrier; (b) about 88-97% (w/w) of the biodegradable matrix; and (c) about 0.017-0.039% (w/w) of the homodimeric protein.

The present disclosure related to a method of promoting healing of a long-bone fracture in a subject in need of such treatment comprising: preparing a composition including a homodimeric protein as previous description homogeneously entrained within a slow release biodegradable calcium phosphate carrier that hardens so as to impermeable to efflux of the homodimeric protein in vivo sufficiently that the long-bone fracture healing is confined to the volume of the calcium phosphate carrier; and implanting the composition at a location where the long-bone fracture occurs, wherein the homodimeric protein is in an amount of from about 0.03 mg/g to about 3.2 mg/g of the calcium phosphate carrier.

In certain embodiments, the method of promoting healing of a long-bone fracture further comprises gradually exposing the entrained homodimeric protein at the location as the calcium phosphate carrier degrades, wherein the calcium phosphate carrier has a calcium to phosphate ratio of about 0.4 to about 1.8.

The present disclosure related a biodegradable composition capable of inducing bone growth to form a bone mass in a location comprises a homodimeric protein as previous description; and a biodegradable calcium phosphate carrier having a plurality of pores. Further, the homodimeric protein is about 0.003-0.32% (w/w).

In certain embodiments, wherein a porosity of the biodegradable calcium phosphate carrier of the biodegradable composition is larger than 70% with pore size from about 300 μm to about 600 μm.

In certain embodiments, the biodegradable calcium phosphate carrier with pores that extend throughout the biodegradable calcium phosphate carrier, wherein the homodimeric protein is in an effective amount of from about 0.03 mg/g to about 3.2 mg/g of the biodegradable calcium phosphate carrier.

In certain embodiments, the biodegradable composition is suitable for augmentation of a tissue selected from nasal furrows, frown lines, midfacial tissue, jaw-line, chin, and cheeks.

In certain embodiments, the location is selected from a long-bone fracture defect, a space between two adjacent vertebra bodies, a non-union bone defect, maxilla osteotomy incision, mandible osteotomy incision, sagittal split osteotomy incision, genioplasty osteotomy incision, rapid palatal expansion osteotomy incision, and a space extending lengthwise between two adjacent transverse processes of two adjacent vertebrae.

In certain embodiments, the single dose of the homodimeric protein is from about 0.006 mg to about 15 mg.

In certain embodiments, the biodegradable calcium phosphate carrier hardens so as to be impermeable to efflux of the homodimeric protein in vivo sufficiently that the formed bone mass is confined to the volume of the biodegradable calcium phosphate carrier.

The present disclosure related to a method for promoting arthrodesis comprising administering the homodimeric protein as previous description and a biodegradable calcium phosphate carrier to a malformed or degenerated joint.

In certain embodiments, the step of administering the homodimeric protein includes administering from about 0.006 mg to about 10.5 mg of the homodimeric protein to the malformed or degenerated joint per treatment.

The present disclosure related to a method for promoting spinal fusion, the method comprising the steps of exposing an upper vertebra and a lower vertebra; identifying a site for fusion between the upper and the lower vertebra; exposing a bone surface on each of the upper and the lower vertebra at the site for fusion; and administering the homodimeric protein as previous description and a biodegradable calcium phosphate carrier to the site.

In certain embodiments, the biodegradable calcium phosphate carrier is a non-compressible delivery vehicle, and wherein the non-compressible delivery vehicle is for application to the site between the two bone surfaces where bone growth is desired but does not naturally occur.

In certain embodiments, the biodegradable calcium phosphate carrier comprises at least one implantation stick for application to the site such that the implantation stick extends lengthwise between the upper and the lower vertebrae.

The present disclosure related a spinal fusion device including a biodegradable composition as previous description; and a spinal fusion cage, configured to retain the biodegradable calcium phosphate carrier.

The present disclosure related to a method of generating a bone mass to fuse two adjacent vertebrae bodies in a spine of a subject in need including the steps of preparing a composition for generating the bone mass, and introducing the composition in a location between the two adjacent vertebrae bodies. Furthermore, the composition including a homodimeric protein as previous description that homogeneously entrained within a slow release biodegradable carrier that hardens so as to be impermeable to efflux of the homodimeric protein in vivo sufficiently that the formed bone mass is confined to the volume of the slow release biodegradable carrier. The slow release biodegradable carrier gradually exposes the entrained homodimeric protein at the location as the slow release biodegradable carrier degrades, and further wherein the homodimeric protein is in an amount of from about 0.2 mg/site to about 10.5 mg/site of the location.

In certain embodiments, the slow release biodegradable carrier has a porous structure, and cells from the two adjacent vertebrae migrates into the porous structure so as to generate the bone mass.

In certain embodiments, the slow release biodegradable carrier has an initial volume, and the bone mass replaces the initial volume of the slow release biodegradable carrier as the slow release biodegradable carrier is resorbed.

The present disclosure related to a method for fusing adjacent vertebrae bodies in a subject in need by a posterior or transforaminal fusion approach including the steps of preparing a disc space for receipt of an intervertebral disc implant in an intervertebral space between the adjacent vertebrae; introducing a slow-release carrier including a homodimeric protein as previous description into the intervertebral disc implant; and introducing the intervertebral disc implant in the disc space between the adjacent vertebrae for generating a bone mass in the disc space. Furthermore, the homodimeric protein is in an amount of from about 0.2 mg/site to about 10.5 mg/site of the slow-release carrier

The present disclosure related to a moldable composition for filling an osseous void including a moldable matrix including about 90% to about 99.5% by weight of the moldable composition; and the homodimeric protein as previous description. Moreover, less than about 25% by percentage of the homodimeric protein is released from the moldable composition after about 1, 24, 48, 72, 168, 240 or about 336 hours post implantation.

The present disclosure related to a sustained release composition including a calcium phosphate carrier; a biodegradable matrix; and a recombinant protein as previous description. Furthermore, the calcium phosphate carrier is about 2-11% (w/w), the biodegradable matrix is about 88-97% (w/w), and the recombinant protein is about 0.017-0.039% (w/w).

In certain embodiments, the calcium phosphate carrier is selected from the group consisting of tricalcium phosphate (TCP), alpha-tricalcium phosphate (α-TCP), beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP) and any combination thereof. In certain embodiments, the biodegradable matrix is selected from the group consisting of polylactic acid (PLA), polyglycolic acid (PGA), polylactic-co-glycolic acid (PLGA), Polyvinyl alcohol (PVA) and any combination thereof.

The present disclosure related to a method for promoting healing of a long-bone fracture in a subject including (a) preparing a composition including a recombinant protein as previous description and a biodegradable calcium phosphate carrier; (b) hardening the composition; and (c) implanting the composition at a location. Furthermore, the location is an injury site in said subject where the long-bone fracture occurs, and the protein is about 0.003-0.32% (w/w).

In certain embodiments, the method further includes (d) exposing the composition at the location as the calcium phosphate carrier degrades. In certain embodiments, the calcium phosphate carrier includes a calcium-to-phosphate ratio of about 0.4-1.8.

The present disclosure related to a method for promoting arthrodesis in a subject including the steps of administering a composition including a recombinant protein as previous description and a biodegradable calcium phosphate carrier to a location in said subject. Furthermore, an amount of the protein is about 0.006-10.5 mg, and the location is selected from the group consisting of a malformed joint, a degenerated joint and combination thereof.

The present disclosure related to a method for promoting spinal fusion in a subject including (a) exposing an upper vertebra and a lower vertebra of said subject; (b) identifying a site for fusion between the upper and the lower vertebra; (c) exposing a bone surface on each of the upper and the lower vertebra at the site for fusion; and (d) administering a recombinant protein as previous describe and a biodegradable calcium phosphate carrier to the site.

In certain embodiments, the biodegradable calcium phosphate carrier is a non-compressible delivery vehicle capable of being applied to the site where bone growth is desired but does not naturally occur.

In certain embodiments, the biodegradable calcium phosphate carrier in the method for promoting spinal fusion includes an implantation stick extending lengthwise between the upper and the lower vertebrae.

The present disclosure related to a spinal fusion device including a biodegradable composition as previous mentioned; and a spinal fusion cage, configured to retain the biodegradable calcium phosphate carrier.

The present disclosure related to a method for generating a bone mass to fuse two adjacent vertebrae bodies in a spine of a subject including (a) preparing a composition for generating the bone mass, the composition including a recombinant protein according to claim 9 and a slow release biodegradable carrier; (b) hardening the composition; (c) introducing the composition between two adjacent vertebrae bodies; and (d) releasing the composition and exposing the protein. Furthermore, the amount of the protein is about 0.2-10.5 mg/site.

In certain embodiments, the slow release biodegradable carrier has a porous structure capable of receiving cells for generating a bone mass.

In certain embodiments, the slow release biodegradable carrier has an initial volume, and the bone mass replaces the initial volume of the slow release biodegradable carrier as the slow release biodegradable carrier is resorbed.

The present disclosure related to a method for fusing adjacent vertebrae bodies in a subject in need including (a) preparing a disc space for receipt of an intervertebral disc implant between adjacent vertebrae; (b) introducing a slow-release carrier including a recombinant protein according to claim 9 into the intervertebral disc implant; (c) introducing the intervertebral disc implant in the disc space; and (d) generating a bone mass in the disc space. Furthermore, the amount of the protein is about 0.2-10.5 mg/site.

The present disclosure related to a moldable composition for implantation into an osseous void including a moldable matrix, and a recombinant protein as previous description. Furthermore, the amount of the moldable matrix is about 90-99.5% (w/w); and less than 25% of the protein is released from the composition after a predetermined period post implantation.

In certain embodiments, the predetermined period is about 1, 24, 48, 72, 168, 240 or 336 hours.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A to 1B show representative X-ray images of female rabbit (strain NZW) ulnae for experimental Groups A-G. The ulna in each experimental group contained a surgically created 20 mm-sized circumferential defect (i.e., a defect site). For Groups A-F, implants were made into the defect sites. The ulna in each of Groups A-E received an implant of 200 mg β-TCP. The β-TCP in Groups A, B, C, and D served as a carrier for 2, 6, 20, and 60 μg, respectively, of a homodimeric protein including two recombinant polypeptides (i.e., SEQ ID NO:260, including intramolecular disulfide bond C44-C48). The β-TCP in Group E did not carry any recombinant polypeptide. Group F received an autograft implant of iliac bone fragments. Group G did not receive any implant into the defect site. X-ray images were taken for each of Groups A-G at: 0 weeks (i.e., immediately after surgery, “0W”) and at 2, 4, 6, and 8 weeks after surgery (i.e., “2W,” “4W,” “6W,” and “8W,” respectively). The site of the implant (Groups A-F) or the defect site (Group G) in the ulna is located immediately above the white asterisk in each image.

FIGS. 2A to 2B show representative computerized tomography (CT) scanning images for experimental Groups A-G. Change in cross-sectional images over time at the center of the implantation site (Groups A-F) or defect site (Group G) is shown 0 weeks (i.e., immediately after surgery, “0W”) and at 4 and 8 weeks after surgery (i.e., “4W” and “8W,” respectively). Groups A-G are as described for FIG. 1.

FIG. 3 shows a graphical representation of the results of torsional strength tests for an intact ulna that was not surgically altered and for experimental Groups A-G (i.e., “A”-“G,” respectively). The maximum torque in Newton-meters (“N-m”) is shown. Groups A-G are as described for FIG. 1.

FIGS. 4-9 show representative X-ray images of sheep spines for experimental Groups 1-6. Groups 1-3 received a single implant of 3.5 g of β-TCP carrying 10.5, 3.5, or 1.05 mg, respectively, of a homodimeric protein including two recombinant polypeptides (i.e., SEQ ID NO:260, including intramolecular disulfide bonds C44-C48, C80-C112, and C79-C114). Group 4 received a single implant of 3.5 g of β-TCP without any homodimeric protein. Group 5 received a single implant of bone autograft. Group 6 received a single implant of absorbable collagen sponge with 3.15 mg of rhBMP-2. FIGS. 4-9 show, from left to right in each figure, radiographs taken post-operatively, at 4 weeks, and at 12 weeks (harvest) from Groups 1-6, respectively. Groups 1-6 are designated in FIGS. 4-9 as “2179,” “2192,” “2187,” “2160,” “2162,” and “2166,” respectively.

FIGS. 10a to 10y show representative X-ray images of female dog (strain beagles) ulnae for five experimental groups (i.e., “Control,” “Hp 35,” “Hp 140,” “Hp 560,” and “Hp 2240,” respectively) taken at 1, 2, 4, 8, and 12 weeks after surgery (i.e., “1W,” “2W,” “4W,” “8W,” and “12W,” respectively). The ulna in each experimental group contained a surgically created 25 mm-sized circumferential defect (i.e., a defect site). For the five groups, implants were made into the defect sites. The implants for the Control, Hp 35, Hp 140, Hp 560, and Hp 2240 experimental groups were 800 mg of β-TCP carrying 0, 35, 140, 560, or 2240 μg, respectively, of a homodimeric protein including two recombinant polypeptides (i.e., SEQ ID NO:260, including intramolecular disulfide bond C44-C48, and intermolecular disulfide bonds C80-C112 and C79-C114).

FIG. 11 shows a graphical representation of an interbody cage. The left images in each row show a top view of the interbody cage, while the right images show a side view. Magnification: top row=×0.67, middle row=×2, bottom row=×4. Cage dimensions: about 8 mm×24 mm×10 mm.

FIG. 12 shows a graphical representation of the range of motion in degrees for: a sheep spine receiving an implant of 150 mg of β-TCP measured at 0 weeks (i.e., “Time Zero”); sheep spines receiving implants of 150 mg of β-TCP carrying 0, 0.1, 0.5, 1.0, 2.0, or 4.0 mg, respectively, of a homodimeric protein including two recombinant polypeptides (i.e., SEQ ID NO:260, including intramolecular disulfide bond C44-C48, and intermolecular disulfide bonds C79-C112 and C80-C114) measured at 12 weeks; and a sheep spine receiving an implant of bone autograft measured at 12 weeks. Sheep were female, strain Ewe. The figure shows the mean and standard deviations for the range of motion for each testing condition and direction.

FIGS. 13A-C show representative micro computed tomography (μCT) axial, coronal, and sagittal images, respectively, of a sheep spine that received an implant with homodimeric protein in an amount of 0.1 mg/site as described for FIG. 12. “V,” “D,” “R,” “L,” “S,” and “I” refer to ventral, dorsal, right, left, superior, and inferior directions, respectively. The site generated bone that largely filled the space within the cage; however, lucency was present at both endplate interfaces.

FIGS. 14A-C show representative μCT axial, coronal, and sagittal images, respectively, of a sheep spine for that received an implant with homodimeric protein in an amount of 0.5 mg/site as described for FIG. 12. “V,” “D,” “R,” “L,” “S,” and “I” are as described for FIGS. 13A-C. The site demonstrated good bone quality but with the presence of some lucent lines within the graft.

FIGS. 15A-C show representative μCT axial, coronal, and sagittal images, respectively, of a sheep spine that received an autograft as described for FIG. 12. “V,” “D,” “R,” “L,” “S,” and “I” are as described for FIGS. 13A-C. The site did not fully fill the cage with bone at the time point. Additionally, there was some lucency within the endplate.

FIGS. 16a and 16b show the relative amount of the homodimeric protein released (FIG. 16a ) and the cumulative percentage of the homodimeric protein released (FIG. 16b ) from microparticles over a 14-day release period.

FIG. 17 shows a representative scanning electron microscopy image of poly lacticco-glycolic acid/homodimeric protein-tricalcium phosphate (PLGA/Hp-β-TCP) stored at −20° C., 4° C. and 25° C. for six months.

FIG. 18 shows representative X-ray images of Balb/C mice tibias at 0 weeks and after 4 weeks of implantation of PLGA/Hp-β-TCP as described for FIG. 17 and with different dosages of homodimeric protein. White arrows in each image identify the bone defects. (Groups=C: necrotic bone control (i.e., bone fragment without implantation of any scaffold), PT: PLGA/β-TCP (i.e., no homodimeric protein), POT-0.2: PLGA/0.2 μg Hp-β-TCP, POT-0.8: PLGA/0.8 Hp-β-TCP, POT-1.6: PLGA/1.6 μg Hp-β-TCP and POT-3.2: PLGA/3.2 μg Hp-β-TCP).

FIG. 19 shows a graphical representation of the percentages of new bone formation/area in osteonecrosis bone after 4 weeks of implantation, with the groups as described for FIG. 18.

FIGS. 20A-D show cross-section representations of example formulations of the present disclosure: granules of a carrier (e.g., β-TCP) carrying polypeptides/proteins of the disclosure (FIG. 20A), a putty mixed with the granules carrying polypeptides/proteins of the disclosure (FIG. 20B), a putty comprising polypeptides/proteins of the disclosure (FIG. 20C), and a putty comprising polypeptides/proteins of the disclosure with granules carrying polypeptides/proteins of the disclosure distributed evenly in the outer layer of the putty (FIG. 20D).

FIG. 21 shows a graphical representation of the cumulative percentage of homodimeric protein released over a duration of specified hours.

DETAILED DESCRIPTION

Provided herein are recombinant polypeptides, homodimeric and heterodimeric proteins comprising the recombinant polypeptides, nucleic acid molecules and vectors encoding the recombinant polypeptides, and host cells for expressing the recombinant polypeptides. The present disclosure also provides compositions of the recombinant polypeptides and methods of making and using the recombinant polypeptides.

All publications cited herein are hereby incorporated by reference in their entireties, including without limitation all journal articles, books, manuals, patent applications, and patents cited herein, to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference.

Terminology

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood to one of ordinary skill in the art to which this disclosure belongs. As used throughout the instant application, the following terms shall have the following meanings.

As used herein and in the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context dictates otherwise. Thus, for example, reference to “a domain” includes a domain or a plurality of such domains and reference to “the recombinant polypeptide” includes reference to one or more recombinant polypeptides, and so forth. The terms “a”, “an,” “the,” “one or more,” and “at least one,” for example, can be used interchangeably herein.

The use of “or” means “and/or” unless stated otherwise. Similarly, “comprise,” “comprises,” “comprising” “include,” “includes,” and “including” are interchangeable and not intended to be limiting.

Furthermore, “and/or” where used herein is to be taken as specific disclosure of each of the two specified features or components with or without the other. Thus, the term “and/or” as used in a phrase such as “A and/or B” herein is intended to include “A and B,” “A or B,” “A” (alone), and “B” (alone). Likewise, the term “and/or” as used in a phrase such as “A, B, and/or C” is intended to encompass each of the following aspects: A, B, and C; A, B, or C; A or C; A or B; B or C; A and C; A and B; B and C; A (alone); B (alone); and C (alone).

It is understood that wherever aspects are described herein with the language “comprising,” otherwise analogous aspects described in terms of “consisting of” and/or “consisting essentially of” are also provided.

“Amino acid” is a molecule having the structure wherein a central carbon atom (the alpha-carbon atom) is linked to a hydrogen atom, a carboxylic acid group (the carbon atom of which is referred to herein as a “carboxyl carbon atom”), an amino group (the nitrogen atom of which is referred to herein as an “amino nitrogen atom”), and a side chain group, R. When incorporated into a peptide, polypeptide, or protein, an amino acid loses one or more atoms of its amino acid carboxylic groups in the dehydration reaction that links one amino acid to another. As a result, when incorporated into a protein, an amino acid is referred to as an “amino acid residue.”

“Protein” or “polypeptide” refers to any polymer of two or more individual amino acids (whether or not naturally occurring) linked via a peptide bond, and occurs when the carboxyl carbon atom of the carboxylic acid group bonded to the alpha-carbon of one amino acid (or amino acid residue) becomes covalently bound to the amino nitrogen atom of amino group bonded to the non alpha-carbon of an adjacent amino acid. The term “protein” is understood to include the terms “polypeptide” and “peptide” (which, at times may be used interchangeably herein) within its meaning. In addition, proteins comprising multiple polypeptide subunits (e.g., DNA polymerase III, RNA polymerase II) or other components (for example, an RNA molecule, as occurs in telomerase) will also be understood to be included within the meaning of “protein” as used herein. Similarly, fragments of proteins and polypeptides are also within the scope of the disclosure and may be referred to herein as “proteins.” In one aspect of the disclosure, a polypeptide comprises a chimera of two or more parental peptide segments. The term “polypeptide” is also intended to refer to and encompass the products of post-translation modification (“PTM”) of the polypeptide, including without limitation disulfide bond formation, glycosylation, carbamylation, lipidation, acetylation, phosphorylation, amidation, derivatization by known protecting/blocking groups, proteolytic cleavage, modification by non-naturally occurring amino acids, or any other manipulation or modification, such as conjugation with a labeling component. A polypeptide can be derived from a natural biological source or produced by recombinant technology, but is not necessarily translated from a designated nucleic acid sequence. It can be generated in any manner, including by chemical synthesis. An “isolated” polypeptide or a fragment, variant, or derivative thereof refers to a polypeptide that is not in its natural milieu. No particular level of purification is required. For example, an isolated polypeptide can simply be removed from its native or natural environment. Recombinantly produced polypeptides and proteins expressed in host cells are considered isolated for the purpose of the disclosure, as are native or recombinant polypeptides which have been separated, fractionated, or partially or substantially purified by any suitable technique.

“Domain” as used herein can be used interchangeably with the term “peptide segment” and refers to a portion or fragment of a larger polypeptide or protein. A domain need not on its own have functional activity, although in some instances, a domain can have its own biological activity.

A particular amino acid sequence of a given protein (i.e., the polypeptide's “primary structure” when written from the amino-terminus to the carboxyl-terminus) is determined by the nucleotide sequence of the coding portion of a mRNA, which is in turn specified by genetic information, typically genomic DNA (including organelle DNA, e.g., mitochondrial or chloroplast DNA). Thus, determining the sequence of a gene assists in predicting the primary sequence of a corresponding polypeptide and more particular the role or activity of the polypeptide or proteins encoded by that gene or polynucleotide sequence.

“N-terminal” as used herein refers to position or location of an amino acid, domain, or peptide segment within a polypeptide in relation to the amino-terminus of the polypeptide. For example, “domain A is N-terminal to domains B and C” means that domain A is located closer to the amino-terminus than domains B and C, such that the order of domains in the polypeptide from the amino-terminus is understood to be either A-B-C or A-C-B when the locations of domains B and C are not otherwise specified. Additionally, any number of amino acids, including none, can be present between a domain that is N-terminal to another domain. Similarly, any number of amino acids, including none, can be present between the N-terminus of the polypeptide and a domain that is N-terminal the other domains in the polypeptide.

“C-terminal” as used herein refers to position or location of an amino acid, domain, or peptide segment within a polypeptide in relation to the carboxyl-terminus of the polypeptide. For example, “domain A is C-terminal to domains B and C” means that domain A is located closer to the carboxyl-terminus than domains B and C, such that the order of domains in the polypeptide from the amino-terminus is understood to be either B-C-A or C-B-A when the locations of domains B and C are not otherwise specified. Additionally, any number of amino acids, including none, can be present between a domain that is C-terminal to another domain. Similarly, any number of amino acids, including none, can be present between the C-terminus of the polypeptide and a domain that is C-terminal the other domains in the polypeptide.

“Intramolecular” and “intermolecular” used herein when referring to disulfide bonds, refer to disulfide bonds that occur within a polypeptide chain and between polypeptide chains, respectively.

“Fused,” “operably linked,” and “operably associated” are used interchangeably herein when referring to two or more domains to broadly refer to any chemical or physical coupling of the two or more domains in the formation of a recombinant polypeptide as disclosed herein. In one embodiment, a recombinant polypeptide as disclosed herein is a chimeric polypeptide comprising a plurality of domains from two or more different polypeptides.

Recombinant polypeptides comprising two or more domains as disclosed herein can be encoded by a single coding sequence that comprises polynucleotide sequences encoding each domain. Unless stated otherwise, the polynucleotide sequences encoding each domain are “in frame” such that translation of a single mRNA comprising the polynucleotide sequences results in a single polypeptide comprising each domain. Typically, the domains in a recombinant polypeptide as described herein will be fused directly to one another or will be separated by a peptide linker. Various polynucleotide sequences encoding peptide linkers are known in the art.

“Homodimeric protein”, “heterodimeric protein”, and “homodimeric or heterodimeric protein” as used herein refers to a protein having two recombinant polypeptides that are identical or different. Therefore, the “homodimeric protein”, “heterodimeric protein”, and “homodimeric or heterodimeric protein” as used herein also refers to the “homodimeric recombinant protein”, “heterodimeric recombinant protein”, and “homodimeric or heterodimeric recombinant protein.” Furthermore, “recombinant protein” as used herein refers to “homodimeric protein”, “heterodimeric protein”, or “homodimeric or heterodimeric protein”.

“Polynucleotide” or “nucleic acid” as used herein refers to a polymeric form of nucleotides. In some instances, a polynucleotide comprises a sequence that is either not immediately contiguous with the coding sequences or is immediately contiguous (on the 5′ end or on the 3′ end) with the coding sequences in the naturally occurring genome of the organism from which it is derived. The term therefore includes, for example, a recombinant DNA which is incorporated into a vector, into an autonomously replicating plasmid or virus, or into the genomic DNA of a prokaryote or eukaryote, or which exists as a separate molecule (e.g., a cDNA) independent of other sequences. The nucleotides of the disclosure can be ribonucleotides, deoxyribonucleotides, or modified forms of either nucleotide. A polynucleotide as used herein refers to, among others, single- and double-stranded DNA, DNA that is a mixture of single- and double-stranded regions, single- and double-stranded RNA, and RNA that is mixture of single- and double-stranded regions, hybrid molecules comprising DNA and RNA that may be single-stranded or, more typically, double-stranded or a mixture of single- and double-stranded regions. The term polynucleotide encompasses genomic DNA or RNA (depending upon the organism, i.e., RNA genome of viruses), as well as mRNA encoded by the genomic DNA, and cDNA. In certain embodiments, a polynucleotide comprises a conventional phosphodiester bond or a non-conventional bond (e.g., an amide bond, such as found in peptide nucleic acids (PNA)). By “isolated” nucleic acid or polynucleotide is intended a nucleic acid molecule, e.g., DNA or RNA, which has been removed from its native environment. For example, a nucleic acid molecule comprising a polynucleotide encoding a recombinant polypeptide contained in a vector is considered “isolated” for the purposes of the present disclosure. Further examples of an isolated polynucleotide include recombinant polynucleotides maintained in heterologous host cells or purified (partially or substantially) from other polynucleotides in a solution. Isolated RNA molecules include in vivo or in vitro RNA transcripts of polynucleotides of the present disclosure. Isolated polynucleotides or nucleic acids according to the present disclosure further include polynucleotides and nucleic acids (e.g., nucleic acid molecules) produced synthetically.

As used herein, a “coding region” or “coding sequence” is a portion of a polynucleotide, which consists of codons translatable into amino acids. Although a “stop codon” (TAG, TGA, or TAA) is typically not translated into an amino acid, it may be considered to be part of a coding region, but any flanking sequences, for example promoters, ribosome binding sites, transcriptional terminators, introns, and the like, are not part of a coding region. The boundaries of a coding region are typically determined by a start codon at the 5′ terminus, encoding the amino-terminus of the resultant polypeptide, and a translation stop codon at the 3′ terminus, encoding the carboxyl-terminus of the resulting polypeptide.

As used herein, the term “expression control region” refers to a transcription control element that is operably associated with a coding region to direct or control expression of the product encoded by the coding region, including, for example, promoters, enhancers, operators, repressors, ribosome binding sites, translation leader sequences, introns, polyadenylation recognition sequences, RNA processing sites, effector binding sites, stem-loop structures, and transcription termination signals. For example, a coding region and a promoter are “operably associated” if induction of promoter function results in the transcription of mRNA comprising a coding region that encodes the product, and if the nature of the linkage between the promoter and the coding region does not interfere with the ability of the promoter to direct the expression of the product encoded by the coding region or interfere with the ability of the DNA template to be transcribed. Expression control regions include nucleotide sequences located upstream (5′ non-coding sequences), within, or downstream (3′ non-coding sequences) of a coding region, and which influence the transcription, RNA processing, stability, or translation of the associated coding region. If a coding region is intended for expression in a eukaryotic cell, a polyadenylation signal and transcription termination sequence will usually be located 3′ to the coding sequence.

“Nucleic acid segment,” “oligonucleotide segment” or “polynucleotide segment” refers to a portion of a larger polynucleotide molecule. The polynucleotide segment need not correspond to an encoded functional domain of a protein; however, in some instances the segment will encode a functional domain of a protein. A polynucleotide segment can be about 6 nucleotides or more in length (e.g., 6-20, 20-50, 50-100, 100-200, 200-300, 300-400 or more nucleotides in length).

A “vector” refers to any vehicle for the cloning of and/or transfer of a nucleic acid molecule into a host cell. The term “vector” includes both viral and nonviral vehicles (e.g., plasmid, phage, cosmid, virus) for introducing the nucleic acid into a cell in vitro, ex vivo or in vivo.

As used herein, the terms “host cell” and “cell” can be used interchangeably and can refer to any type of cell or a population of cells, e.g., a primary cell, a cell in culture, or a cell from a cell line, that harbors or is capable of harboring a nucleic acid molecule (e.g., a recombinant nucleic acid molecule). Host cells can be a prokaryotic cell, or alternatively, the host cells can be eukaryotic, for example, fungal cells, such as yeast cells, and various animal cells, such as insect cells or mammalian cells.

“Culture,” “to culture” and “culturing,” as used herein, means to incubate cells under in vitro conditions that allow for cell growth or division or to maintain cells in a living state. “Cultured cells,” as used herein, means cells that are propagated in vitro.

“Osteoinductive” as used herein refers to the induction of bone and/or cartilage formation or growth, including, for example, the induction of a marker associated with bone and/or cartilage formation or growth (e.g., the induction of alkaline phosphatase activity).

“Yeast two-hybrid assay” or “yeast two-hybrid system” is used interchangeably herein and refers to an assay or system for the detection of interactions between protein pairs. In a typical two-hybrid screening assay/system, a transcription factor is split into two separate fragments, the binding domain (BD) and the activation domain (AD), each of which is provided on a separate plasmid, and each of which is fused to a protein of interest. The yeast two-hybrid assay system comprises (i) a “bait” vector, comprising a bait protein and the BD of the transcription factor utilized in the system; (ii) a “prey” vector, comprising a prey protein (or a library of prey proteins to be screened for interaction with the bait protein) and the AD of the transcription factor; and (iii) a suitable reporter yeast strain containing the binding sequence for the BD of the transcription factor used in the system. When the bait-prey interaction occurs, the AD of the transcription factor drives the expression of one or more reporter proteins. The bait and prey vectors are introduced into the reporter yeast strain, wherein the expressed bait and prey proteins may interact. Alternatively, separate haploid yeast strains each containing either a bait vector or a prey vector can be mated and the resulting diploid yeast strain expresses both proteins. Interacting bait and prey protein pairs result in the reconstitution and activation of the transcription factor, which then binds to its compatible activation domain provided in the reporter yeast strain, which in turn triggers the expression of the reporter gene, which may then be detected.

Recombinant Polypeptides and Compositions

The present disclosure is directed to a recombinant polypeptide comprising any two or more domains selected from the group consisting of SEQ ID NOs: 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53, 55, 57, 59, 61, 63, 65, 67, 69, 71, 73, 75, 77, and 355, including, without limitation, any of the combinations of two domains disclosed in Table 3 herein. In certain embodiments, the recombinant polypeptide comprises any three of the domains, including, without limitation to, any of the combinations of three domains disclosed in Table 3, herein.

Any domain of a recombinant polypeptide as described herein can be located at any position with respect to the amino-terminus or carboxyl-terminus of the recombinant polypeptide. For example, any domain of a recombinant polypeptide as disclosed herein can be located N-terminal to any one or more other domains in the recombinant polypeptide. Similarly, any domain of a recombinant polypeptide as disclosed here can be located C-terminal to any one or more other domains in the recombinant polypeptide.

The present disclosure is directed to a recombinant polypeptide comprising any two or more domains selected from the group consisting SEQ ID NOs: 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53, 55, 57, 59, 61, 63, 65, 67, 69, 71, 73, 75, 77, and 355 that has a higher affinity for the extracellular domain of activin receptor IIB protein (i.e., ActRIIBecd) than any of the individual domains in the recombinant polypeptide. Nucleic acid sequences and polypeptide sequences of ActRIIB and naturally occurring variants are known. For example, ActRIIBecd can be SEQ ID NO: 9 as disclosed herein, which corresponds to residues 27-117 of SEQ ID NO: 8 as disclosed herein. Affinity can be as measured, e.g., by a radioimmunoassay (RIA), surface plasmon resonance, such as BIAcore™, or any other binding assay known in the art. In some embodiments, such recombinant polypeptides include the combination of two domains, wherein either of the two domains is located N-terminal or C-terminal to the other domain, selected from the following combinations of domains: SEQ ID NO: 39 and SEQ ID NO: 49, SEQ ID NO: 49 and SEQ ID NO: 61, SEQ ID NO: 61 and SEQ ID NO:39, SEQ ID NO: 35 and SEQ ID NO: 47, SEQ ID NO: 57 and SEQ ID NO: 35, and SEQ ID NO: 57 and SEQ ID NO: 47. In some embodiments, such combination of two domains yields a recombinant polypeptide comprising a sequence selected from the group consisting of: SEQ ID NOs: 188, 194, 200, 206, 212, 218, 224, 230, 236, 242, 248, and 254. In some embodiments, such recombinant polypeptides include the combination of three domains, wherein any domain is located N-terminal or C-terminal to one or both of the other domains, selected from the following combinations of domains: SEQ ID NOs: 39, 49, and 61; SEQ ID NOs: 35, 47, and 57; SEQ ID NOs: 39, 47, and 61; SEQ ID NOs: 35, 49, and 57; SEQ ID NOs: 39, 57, and 47; and SEQ ID NOs: 35, 61, and 49. In some embodiments, such combination of three domains yields a recombinant polypeptide comprising a sequence selected from the group consisting of: SEQ ID NOs: 260, 268, 276, 284, 292, 300, 308, 316, 324, 332, 340, and 348.

The present disclosure is directed to a recombinant polypeptide comprising a first domain of SEQ ID NO: 39, a second domain of SEQ ID NO: 49, and a third domain of SEQ ID NO: 61, wherein the first domain is located C-terminal to the second domain, the third domain is located N-terminal to the second domain, or a combination thereof. In certain embodiments, the recombinant polypeptide comprises a first domain selected from the group consisting of SEQ ID NO: 35 and SEQ ID NO: 39, a second domain selected from the group consisting of SEQ ID NO: 47 and SEQ ID NO: 49, and a third domain selected from the group consisting of SEQ ID NO: 57 and SEQ ID NO: 61, wherein the first domain is located C-terminal to the second domain, the third domain is located N-terminal to the second domain, or a combination thereof when the first, second, and third domains are SEQ ID NOs: 39, 49, and 61, respectively.

In certain embodiments, a recombinant polypeptide as described herein comprises a post-translation modification (“PTM”), including without limitation disulfide bond formation, glycosylation, carbamylation, lipidation, acetylation, phosphorylation, amidation, derivatization by known protecting/blocking groups, proteolytic cleavage, modification by non-naturally occurring amino acids, or any other manipulation or modification, such as conjugation with a labeling component.

In certain embodiments, a recombinant polypeptide can include one or more cysteines capable of participating in formation of one or more disulfide bonds under physiological conditions or any other standard condition (e.g., purification conditions or storage conditions). In certain embodiments, a disulfide bond is an intramolecular disulfide bond formed between two cysteine residues in the recombinant polypeptide. In certain embodiments, a disulfide bond is an intermolecular disulfide bond formed between two recombinant polypeptides in a dimer. In certain embodiments, an intermolecular disulfide bond is formed between two identical recombinant polypeptides as described herein, wherein the two identical recombinant polypeptides form a homodimer. In certain embodiments, a homodimer includes at least one or more than three intermolecular disulfide bonds. In certain embodiments, an intermolecular disulfide bond is formed between two different recombinant polypeptides as described herein, wherein the two different recombinant polypeptides form a heterodimer. In certain embodiments, a heterodimer includes at least one or more than three intermolecular disulfide bonds.

The present disclosure is directed to a recombinant polypeptide comprising a first domain selected from the group consisting of SEQ ID NO: 35 and SEQ ID NO: 39, a second domain selected from the group consisting of SEQ ID NO: 47 and SEQ ID NO: 49, and a third domain selected from the group consisting of SEQ ID NO: 57 and SEQ ID NO: 61, wherein the recombinant polypeptide comprises an intramolecular disulfide bond.

In certain embodiments, the first domain, second domain, third domain, or combinations thereof comprise an intramolecular disulfide bond. In certain embodiments, one or more intramolecular disulfide bonds are within a single domain, are between one domain and another domain, are between one domain with more than two cysteines and one or more other domains, or a combination thereof. In certain embodiments, the first domain comprises a disulfide bond. In certain embodiments, the second domain comprises a disulfide bond. In certain embodiments, the third domain comprises a disulfide bond. In certain embodiments, each domain comprises a disulfide bond. “Domain comprises a disulfide bond” as used herein when referring to an intramolecular disulfide bond refers to a disulfide bond between two cysteines in a single domain when more than one cysteine is present in a domain or between a cysteine in one domain and a cysteine in another domain.

In certain embodiments, the second domain of a recombinant polypeptide as described herein comprises an intramolecular disulfide bond between the twenty-third amino acid of the second domain and the twenty-seventh amino acid of the second domain. In certain embodiments, the recombinant polypeptide further comprises one or more additional intramolecular disulfide bonds between the first domain and the third domain, within the third domain, or both. In certain embodiments, the recombinant polypeptide further comprises an intramolecular disulfide bond between the ninth amino acid of the third domain and the forty-third amino acid of the third domain, between the eighth amino acid of the third domain and the forty-first amino acid of the third domain, between the eighth amino acid of the third domain and the forty-third amino acid of the third domain, or between the ninth amino acid of the third domain and the forty-first amino acid of the third domain. In certain embodiments, the recombinant polypeptide further comprises a disulfide bond between the ninth amino acid of the third domain and the forty-third amino acid of the third domain, and a disulfide bond between the eighth amino acid of the third domain and the forty-first amino acid of the third domain. In certain embodiments, the recombinant polypeptide further comprises a disulfide bond between the eighth amino acid of the third domain and the forty-third amino acid of the third domain, and a disulfide bond between the ninth amino acid of the third domain and the forty-first amino acid of the third domain.

In certain embodiments, the third domain of a recombinant polypeptide as described herein comprises a first amino acid sequence of PKACCVPTE (SEQ ID NO: 356) and a second amino acid sequence of GCGCR (SEQ ID NO: 357), wherein the third domain comprises either two intramolecular disulfide bonds or two intermolecular disulfide bonds between the first and second amino acid sequences. In certain embodiments, the recombinant polypeptide comprises a first intramolecular or intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence and the second amino acid of the second amino acid sequence, and a second intramolecular or intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence and the fourth amino acid of the second amino acid sequence. In certain embodiments, the recombinant polypeptide comprises a first intramolecular or intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence and the second amino acid of the second amino acid sequence, and a second intramolecular or intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence and the fourth amino acid of the second amino acid sequence. In certain embodiments, the recombinant polypeptide further comprises an intramolecular disulfide bond between the twenty-third amino acid of the second domain and the twenty-seventh amino acid of the second domain.

The present disclosure is directed to a recombinant polypeptide comprising an amino acid sequence selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 268, SEQ ID NO: 276, SEQ ID NO: 284, SEQ ID NO: 292, SEQ ID NO: 300, SEQ ID NO: 308, SEQ ID NO: 316, SEQ ID NO: 324, SEQ ID NO: 332, SEQ ID NO: 340, and SEQ ID NO: 348, wherein the recombinant polypeptide comprises an intramolecular disulfide bond. In certain embodiments, the intramolecular disulfide bond comprises one or more disulfide bonds comprising cysteine 15, cysteine 44, cysteine 48, cysteine 79, cysteine 80, cysteine 112, cysteine 114, and combinations thereof, as numbered from the amino-terminus of a recombinant polypeptide selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 292, SEQ ID NO: 324, and SEQ ID NO: 332. In certain embodiments, the intramolecular disulfide bond comprises cysteine 44, cysteine 48, or both as numbered from the amino-terminus of a recombinant polypeptide selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO:292, SEQ ID NO: 324, and SEQ ID NO: 332.

In certain embodiments, a recombinant polypeptide selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 292, SEQ ID NO: 324, and SEQ ID NO: 332 comprises an intramolecular disulfide bond between cysteine 44 and cysteine 48, as numbered from the amino-terminus of the recombinant polypeptide. In certain embodiments, the recombinant polypeptide further comprises either an intramolecular or intermolecular (i.e., in a dimer) disulfide bond between cysteine 79 and cysteine 112, between cysteine 80 and cysteine 114, between cysteine 80 and cysteine 112, or between cysteine 79 and cysteine 114. In certain embodiments, the recombinant polypeptide further comprises either an intramolecular or intermolecular disulfide bond between cysteine 79 and cysteine 112, and either an intramolecular or intermolecular disulfide bond between cysteine 80 and cysteine 114. In certain embodiments, the recombinant polypeptide further comprises either an intramolecular or intermolecular disulfide bond between cysteine 80 and cysteine 112, and either an intramolecular or intermolecular disulfide bond between cysteine 79 and cysteine 114.

The present disclosure is directed to a homodimeric protein comprising two identical recombinant polypeptides as described herein.

The present disclosure is directed to a heterodimeric protein comprising two different recombinant polypeptides as described herein.

In certain embodiments, a homodimeric protein or heterodimeric protein as described herein comprises one or more intermolecular disulfide bonds between the first domains of the two recombinant polypeptides, between the second domains of the two recombinant polypeptides, between the third domains of the two recombinant polypeptides, between the first and second domains of the two recombinant polypeptides, between the first and third domains of the two recombinant polypeptides, between the second and third domains of the two recombinant polypeptides, or combinations thereof.

In certain embodiments, a homodimeric or heterodimeric protein as described herein comprises an intermolecular disulfide bond between the fifteenth amino acid of the first domain of one recombinant polypeptide and the fifteenth amino acid of the first domain of the other recombinant polypeptide. In certain embodiments, the homodimeric or heterodimeric protein further comprises an intermolecular disulfide bond between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide, between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, or between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide. In certain embodiments, the homodimeric or heterodimeric protein further comprises a disulfide bond between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, and a disulfide bond between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide. In certain embodiments, the homodimeric or heterodimeric protein further comprises a disulfide bond between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, and a disulfide bond between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide.

In certain embodiments, the homodimeric or heterodimeric protein comprises an intermolecular disulfide bond between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide, between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, or between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide. In certain embodiments, the homodimeric or heterodimeric protein comprises a disulfide bond between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, and a disulfide bond between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide. In certain embodiments, the homodimeric or heterodimeric protein comprises a disulfide bond between the eighth amino acid of the third domain of one recombinant polypeptide and the forty-third amino acid of the third domain of the other recombinant polypeptide, and a disulfide bond between the ninth amino acid of the third domain of one recombinant polypeptide and the forty-first amino acid of the third domain of the other recombinant polypeptide.

In certain embodiments, the third domain of each recombinant polypeptide of a homodimeric or heterodimeric protein as described herein comprises a first amino acid sequence of PKACCVPTE (SEQ ID NO: 356) and a second amino acid sequence of GCGCR (SEQ ID NO: 357), wherein the homodimeric or heterodimeric protein comprises two intermolecular disulfide bonds between the first amino acid sequence in the third domain of one recombinant polypeptide and the second amino acid sequence in the third domain of the other recombinant polypeptide. In certain embodiments, the homodimeric or heterodimeric protein comprises a first intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the other recombinant polypeptide, and a second intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the other recombinant polypeptide. In certain embodiments, the homodimeric or heterodimeric protein comprises a first intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the other recombinant polypeptide, and a second intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the other recombinant polypeptide.

In certain embodiments, one or both of the recombinant polypeptides of a homodimeric or heterodimeric protein as described herein comprises any one or more of the intramolecular disulfide bonds as described herein.

In certain embodiments, the second domain of one or both of the recombinant polypeptides of a homodimeric or heterodimeric protein as described herein comprises an intramolecular disulfide bond. In certain embodiments, one or both of the recombinant polypeptides of a homodimeric or heterodimeric protein as described herein comprises an intramolecular disulfide bond between the twenty-third amino acid of the second domain and the twenty-seventh amino acid of the second domain.

In certain embodiments, one or both of the recombinant polypeptides of a homodimeric or heterodimeric protein as described herein comprises an intramolecular disulfide bond between cysteine 44 and cysteine 48 for any of SEQ ID NOs: 260, 292, 324, or 332, between cysteine 88 and cysteine 92 for any of SEQ ID NOs: 284, 308, 340, 348, between cysteine 23 and cysteine 27 for SEQ ID NOs: 268 or 300, or between cysteine 67 and cysteine 71 for SEQ ID NOs: 276 or 316, as numbered from the amino-terminus of the recombinant polypeptide.

In certain embodiments, a homodimeric protein as described herein comprises two recombinant polypeptides, wherein each polypeptide comprises the same sequence, and wherein the sequence is selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 268, SEQ ID NO: 276, SEQ ID NO: 284, SEQ ID NO: 292, SEQ ID NO: 300, SEQ ID NO: 308, SEQ ID NO: 316, SEQ ID NO: 324, SEQ ID NO: 332, SEQ ID NO: 340, and SEQ ID NO: 348. In some embodiments, the recombinant polypeptides comprise identical intramolecular disulfide bonds as described herein. In some embodiments, the recombinant polypeptides comprise different intramolecular disulfide bonds as described herein.

In certain embodiments, a heterodimeric protein as described herein comprises two different recombinant polypeptides, wherein each polypeptide comprises a different sequence selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 268, SEQ ID NO: 276, SEQ ID NO: 284, SEQ ID NO: 292, SEQ ID NO: 300, SEQ ID NO: 308, SEQ ID NO: 316, SEQ ID NO: 324, SEQ ID NO: 332, SEQ ID NO: 340, and SEQ ID NO: 348. In certain embodiments, one recombinant polypeptide in the heterodimeric protein comprises the sequence of SEQ ID NO: 260 and the other recombinant polypeptide comprises a sequence selected from the group consisting of: SEQ ID NO: 268, SEQ ID NO: 276, SEQ ID NO: 284, SEQ ID NO: 292, SEQ ID NO: 300, SEQ ID NO: 308, SEQ ID NO: 316, SEQ ID NO: 324, SEQ ID NO: 332, SEQ ID NO: 340, and SEQ ID NO: 348. In some embodiments, the recombinant polypeptides comprise identical intramolecular disulfide bonds as described herein. In some embodiments, the recombinant polypeptides comprise different intramolecular disulfide bonds as described herein.

In certain embodiments, a recombinant polypeptide, homodimeric protein, or heterodimeric protein as described herein comprises one or more of the disulfide bonds between cysteine pairs as listed in Table 4 or Table 5 herein.

In certain embodiments, a recombinant polypeptide, homodimeric protein, or heterodimeric protein as described herein comprises an osteoinductive activity. Osteoinductive activity can be measured under any conditions routinely practiced for measuring such activity (i.e., “osteoinductive conditions”).

For example, C2C12 cells are a murine myoblast cell line from dystrophic mouse muscle. Exposure of C2C12 cells to a polypeptide with osteoinductive activity can shift C2C12 cell differentiation from muscle to bone, for example, by inducing osteoblast formation characterized by expression of a bone-associated protein such as alkaline phosphatase. Alkaline phosphatase is a widely accepted bone marker, and assays for detection of alkaline phosphatase activity are accepted as demonstrating osteoinductive activity. See, e.g., Peel et al., J. Craniofacial Surg. 14: 284-291 (2003); Hu et al., Growth Factors 22: 29033 (2004); and Kim et al., J. Biol. Chem. 279: 50773-50780 (2004).

In certain embodiments, a recombinant polypeptide, homodimeric protein, or heterodimeric protein as described herein is capable of inducing alkaline phosphatase activity.

In certain embodiments, osteoinductive activity is detected by a medical imaging technology or histological examination of bone samples, or any other method routinely practiced for detection of bone formation or growth. In certain embodiments, the detection comprises radiographic imaging, such as X-ray imaging. In certain embodiments, the detection comprises computed tomography (CT) scanning. In some embodiments, the detection comprises molecular imaging or nuclear imaging (i.e., positron emission tomography (PET)). In certain embodiments, the detection comprises histological examination. In certain embodiments, the detection comprises hematoxylin and eosin (HE)-staining.

In certain embodiments, a recombinant polypeptide, homodimeric protein, or heterodimeric protein as described herein can include fragment, variant, or derivative molecules thereof without limitation. The terms “fragment,” “variant,” “derivative” and “analog” when referring to a polypeptide include any polypeptide which retains at least some property or biological activity of the reference polypeptide. Polypeptide fragments can include proteolytic fragments, deletion fragments, and fragments which more easily reach the site of action when implanted in an animal. Polypeptide fragments can comprise variant regions, including fragments as described above, and also polypeptides with altered amino acid sequences due to amino acid substitutions, deletions, or insertions. Non-naturally occurring variants can be produced using art-known mutagenesis techniques. Polypeptide fragments of the disclosure can comprise conservative or non-conservative amino acid substitutions, deletions, or additions. Variant polypeptides can also be referred to herein as “polypeptide analogs.” Polypeptide fragments of the present disclosure can also include derivative molecules. As used herein a “derivative” of a polypeptide or a polypeptide fragment refers to a subject polypeptide having one or more residues chemically derivatized by reaction of a functional side group. Also included as “derivatives” are those peptides which contain one or more naturally occurring amino acid derivatives of the twenty standard amino acids. For example, 4-hydroxyproline can be substituted for proline; 5-hydroxylysine can be substituted for lysine; 3-methylhistidine can be substituted for histidine; homoserine can be substituted for serine; and ornithine can be substituted for lysine.

In certain embodiments, a recombinant polypeptide, homodimeric protein, or heterodimeric protein as described herein comprises a label. In certain embodiments, the label is an enzymatic label that can catalyze the chemical alteration of a substrate compound or composition, a radiolabel, a fluorophore, a chromophore, an imaging agent, or a metal, including a metal ion.

In certain embodiments, a recombinant polypeptide as described herein comprises one or more conservative amino acid substitutions. A “conservative amino acid substitution” is a substitution of an amino acid with different amino acid residue having a similar side chain. Families of amino acid residues having similar side chains have been defined in the art, including basic side chains (e.g., lysine, arginine, histidine), acidic side chains (e.g., aspartic acid, glutamic acid), uncharged polar side chains (e.g., glycine, asparagine, glutamine, serine, threonine, tyrosine, cysteine), nonpolar side chains (e.g., alanine, valine, leucine, isoleucine, proline, phenylalanine, methionine, tryptophan), beta-branched side chains (e.g., threonine, valine, isoleucine) and aromatic side chains (e.g., tyrosine, phenylalanine, tryptophan, histidine). Thus, if an amino acid in a polypeptide is replaced with another amino acid from the same side chain family, the substitution is considered to be conservative. In another embodiment, a string of amino acids can be conservatively replaced with a structurally similar string that differs in order and/or composition of side chain family members.

In certain embodiments, a recombinant polypeptide of the disclosure is encoded by a nucleic acid molecule or vector of the disclosure as described herein, or is expressed by a host cell as described herein.

Nucleic Acid Molecules, Vectors, and Host Cells

The present disclosure is directed to an isolated nucleic acid molecule comprising a polynucleotide sequence encoding any of the recombinant polypeptides described herein.

In certain embodiments, the isolated nucleic acid molecule comprises any two or more polynucleotide sequences encoding a domain as described herein. In certain embodiments, the isolated nucleic acid molecule comprises any two or more polynucleotide sequences selected from the group consisting of SEQ ID NOs: 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72, 74, 76, and 78, which encode domains described herein corresponding to SEQ ID NOs: 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53, 55, 57, 59, 61, 63, 65, 67, 69, 71, 73, 75, 77, and 355, respectively. In certain embodiments, the isolated nucleic acid molecule comprises any combination of two or three polynucleotide sequences encoding the corresponding combinations of two or three domains shown in Table 3, herein.

In certain embodiments, the isolated nucleic acid molecule comprises a polynucleotide sequence selected from the group consisting of SEQ ID NOs: 115, 157, 187, 193, 199, 205, 211, 217, 223, 229, 235, 241, 247, 253, 259, 267, 275, 283, 291, 299, 307, 315, 323, 331, 339, and 347, which encodes a recombinant polypeptide described herein corresponding to SEQ ID NOs: 116, 158, 188, 194, 200, 206, 212, 218, 224, 230, 236, 242, 248, 254, 260, 268, 276, 284, 292, 300, 308, 316, 324, 332, 340, and 348, respectively.

In certain embodiments, the polynucleotide sequence is codon-optimized.

The present disclosure is directed to a recombinant nucleic acid molecule comprising an expression control region operably linked to an isolated nucleic acid molecule as described herein. In certain embodiments, the expression control region is a promoter, enhancer, operator, repressor, ribosome binding site, translation leader sequence, intron, polyadenylation recognition sequence, RNA processing site, effector binding site, stem-loop structure, transcription termination signal, or combination thereof. In certain embodiments, the expression control region is a promoter. An expression control region can be a transcription control region and/or a translation control region.

A variety of transcription control regions are known to those skilled in the art. These include, without limitation, transcription control regions, which function in vertebrate cells, such as, but not limited to, promoter and enhancer segments from cytomegaloviruses (the immediate early promoter, in conjunction with intron-A), simian virus 40 (the early promoter), and retroviruses (such as Rous sarcoma virus). Other transcription control regions include those derived from vertebrate genes such as actin, heat shock protein, bovine growth hormone and rabbit ß-globin, as well as other sequences capable of controlling gene expression in eukaryotic cells. Additional suitable transcription control regions include tissue-specific promoters and enhancers as well as lymphokine-inducible promoters (e.g., promoters inducible by interferons or interleukins).

Similarly, a variety of translation control elements are known to those of ordinary skill in the art. These include, but are not limited to ribosome binding sites, translation initiation and termination codons, and elements derived from picornaviruses (particularly an internal ribosome entry site, or IRES, also referred to as a CITE sequence).

In certain embodiments, the recombinant nucleic acid molecule is a recombinant vector.

A vector can be any vehicle for the cloning of and/or transfer of a nucleic acid into a host cell. A large number of vectors are known and used in the art including, for example, plasmids, phages, cosmids, chromosomes, viruses, modified eukaryotic viruses, modified bacterial viruses. Insertion of a polynucleotide into a suitable vector can be accomplished by ligating the appropriate polynucleotide fragments into a chosen vector that has complementary cohesive termini.

Vectors can be engineered to encode selectable markers or reporters that provide for the selection or identification of cells that have incorporated the vector. Expression of selectable markers or reporters allows identification and/or selection of host cells that incorporate and express other coding regions contained on the vector. Examples of selectable marker genes known and used in the art include: genes providing resistance to ampicillin, streptomycin, gentamycin, kanamycin, hygromycin, neomycin, puromycin, bialaphos herbicide, sulfonamide, and the like; and genes that are used as phenotypic markers, i.e., anthocyanin regulatory genes, isopentanyl transferase gene, and the like. Examples of reporters known and used in the art include: luciferase (Luc), green fluorescent protein (GFP), chloramphenicol acetyltransferase (CAT), beta-galactosidase (LacZ), beta-glucuronidase (Gus), and the like. Selectable markers may also be considered to be reporters.

The term “plasmid” refers to an extra-chromosomal element often carrying a gene that is not part of the central metabolism of the cell, and usually in the form of circular double-stranded DNA molecules. Such elements can be autonomously replicating sequences, genome integrating sequences, phage or nucleotide sequences, linear, circular, or supercoiled, of a single- or double-stranded DNA or RNA, derived from any source, in which a number of nucleotide sequences have been joined or recombined into a unique construction which is capable of introducing a promoter fragment and DNA sequence for a selected gene product along with appropriate 3′ untranslated sequence into a cell.

Eukaryotic viral vectors that can be used include, but are not limited to, adenovirus vectors, retrovirus vectors, adeno-associated virus vectors, and poxvirus, e.g., vaccinia virus vectors, baculovirus vectors, or herpesvirus vectors. Non-viral vectors include plasmids, liposomes, electrically charged lipids (cytofectins), DNA-protein complexes, and biopolymers. Mammalian expression vectors can comprise nontranscribed elements such as an origin of replication, a suitable promoter and enhancer linked to the gene to be expressed, and other 5′ or 3′ flanking nontranscribed sequences, and 5′ or 3′ nontranslated sequences, such as necessary ribosome binding sites, a polyadenylation site, splice donor and acceptor sites, and transcriptional termination sequences.

The recombinant vector can be a “recombinant expression vector,” which refers to any nucleic acid construct which contains the necessary elements for the transcription and translation of an inserted coding sequence, or in the case of an RNA viral vector, the necessary elements for replication and translation, when introduced into an appropriate host cell.

The present disclosure is directed to a method of making a recombinant vector comprising inserting an isolated nucleic acid molecule as described herein into a vector.

The present disclosure is directed to an isolated host cell comprising an isolated nucleic acid molecule or recombinant nucleic acid molecule as described herein. In certain embodiments, the isolated host cell comprises a recombinant vector as described herein.

Nucleic acid molecules can be introduced into host cells by methods well known in the art, e.g., transfection, electroporation, microinjection, transduction, cell fusion, DEAE dextran, calcium phosphate precipitation, lipofection (lysosome fusion), use of a gene gun, or a DNA vector transporter.

The present disclosure is directed to a method of making a recombinant host cell comprising introducing an isolated nucleic acid molecule or recombinant nucleic acid molecule as described herein into a host cell. In certain embodiments, the method comprises introducing a recombinant vector as described herein into a host cell.

A host cell as described herein can express any of the isolated nucleic acid molecules or recombinant nucleic acid molecules described herein. The term “express” as used with respect to expression of a nucleic acid molecule in a host cell refers to a process by which a gene produces a biochemical, for example, a RNA or polypeptide. The process includes any manifestation of the functional presence of the gene within the cell including, without limitation, transient expression or stable expression. It includes, without limitation, transcription of the gene into messenger RNA (mRNA), and the translation of such mRNA into polypeptide(s).

Host cells include, without limitation, prokaryotes or eukaryotes. Representative examples of appropriate host cells include bacterial cells; fungal cells, such as yeast; insect cells; and isolated animal cells. Bacterial cells can include, without limitation, gram negative or gram positive bacteria, for example Escherichia coli. Alternatively, a Lactobacillus species or Bacillus species can be used as a host cell. Eukaryotic cells can include, but are not limited to, established cell lines of mammalian origin. Examples of suitable mammalian cell lines include COS-7, L, C127, 3T3, Chinese hamster ovary (CHO), HeLa, and BHK cell lines.

The host cells can be cultured in conventional nutrient media modified as appropriate for activating promoters, selecting transformants, or amplifying nucleic acid molecules of the present disclosure. The culture conditions, such as temperature, pH, and the like, can be any conditions known to be used or routinely modified when using the host cell selected for expression, and will be apparent to the ordinarily skilled artisan.

The present disclosure is directed to a method of producing a recombinant polypeptide, comprising: culturing an isolated host cell as described herein and isolating the recombinant polypeptide from the host cell. Techniques for isolating polypeptides from cultured host cells can be any technique known to be used or routinely modified when isolating polypeptides from the host cell selected for expression, and will be apparent to the ordinarily skilled artisan.

Compositions and Devices

The present disclosure is directed to a composition comprising a recombinant polypeptide, homodimeric protein, or heterodimeric protein as described herein.

In certain embodiments, the composition further comprises a physiologically acceptable carrier, excipient, or stabilizer. See, e.g., Remington's Pharmaceutical Sciences (1990) Mack Publishing Co., Easton, Pa. Acceptable carriers, excipients, or stabilizers can include those that are nontoxic to a subject. In certain embodiments, the composition or one or more components of the composition are sterile. A sterile component can be prepared, for example, by filtration (e.g., by a sterile filtration membrane) or by irradiation (e.g., by gamma irradiation).

In certain embodiments, a composition as described herein further comprises an allograft or autograft of bone or bone fragments.

In certain embodiments, a composition as described herein further comprises a bone graft substitute.

In certain embodiments, the bone graft substitute is a bioceramic material. The terms “bioceramic material” and “bioceramic” can be used interchangeably herein. In certain embodiments, the bioceramic is biocompatible and is resorbable in vivo. In certain embodiments, the bioceramic is any calcium phosphate salt-based bioceramic. In certain embodiments, the bioceramic is selected from the group consisting of tricalcium phosphate (TCP), alpha-tricalcium phosphate (α-TCP), beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), hydroxylapatite, calcium sulfate, and calcium carbonate. In certain embodiments, the bioceramic is beta-tricalcium phosphate (β-TCP).

In certain embodiments, the bone graft substitute is a bioactive glass. In certain embodiments, the bioactive glass comprises silicon dioxide (SiO₂), sodium oxide (Na₂O), calcium oxide (CaO), or platinum oxide (Pt₂O₅).

The present disclosure is directed to a biodegradable composition, comprising: a homodimeric protein as disclosed herein, being able to induce bone growth to form a bone mass in a location; and a biodegradable calcium phosphate carrier (e.g., β-TCP) with pores that extend throughout the biodegradable calcium phosphate carrier, wherein the homodimeric protein is in an effective amount of from about 0.03 mg/g to about 3.2 mg/g of the biodegradable calcium phosphate carrier and porosity of the biodegradable calcium phosphate carrier is more than 70% with pore size from about 300 μm to about 600 μm.

In certain embodiments, the biodegradable composition is suitable for augmentation of a tissue selected from the group consisting of: nasal furrows, frown lines, midfacial tissue, jaw-line, chin, cheeks, and combinations thereof.

In certain embodiments, the location is selected from the group consisting of: a long-bone fracture defect, a space between two adjacent vertebra bodies, a non-union bone defect, maxilla osteotomy incision, mandible osteotomy incision, sagittal split osteotomy incision, genioplasty osteotomy incision, rapid palatal expansion osteotomy incision, a space extending lengthwise between two adjacent transverse processes of two adjacent vertebrae, and combinations thereof.

In certain embodiments, a single dose of the homodimeric protein is from about 0.006 mg to about 15 mg.

In certain embodiments, the biodegradable calcium phosphate carrier hardens so as to be impermeable to efflux of the homodimeric protein in vivo sufficiently that the formed bone mass is confined to the volume of the biodegradable calcium phosphate carrier.

The present disclosure is directed to a sustained release composition, comprising a calcium phosphate carrier, a biodegradable matrix, and a homodimeric protein as disclosed herein.

In certain embodiments, the calcium phosphate carrier is selected from the group consisting of: tricalcium phosphate (TCP), alpha-tricalcium phosphate (α-TCP), beta-tricalcium phosphate (β-TCP), biphasic calcium phosphate (BCP), and combinations thereof.

In certain embodiments, the biodegradable matrix is selected from the group consisting of: polylactic acid (PLA), polyglycolic acid (PGA), polylactic-co-glycolic acid (PLGA), Polyvinyl alcohol (PVA), and combinations thereof.

In certain embodiments, the sustained release composition comprises: (a) about 2-11% (w/w) of the calcium phosphate carrier; (b) about 88-97% (w/w) of the biodegradable matrix; and (c) about 0.017-0.039% (w/w) of the homodimeric protein.

The present disclosure is directed to a moldable composition for filling an osseous void, comprising: a moldable matrix comprising about 90% to about 99.5% by weight of the moldable composition; and a homodimeric protein as disclosed herein, wherein less than about 25% by percentage of the homodimeric protein is released from the moldable composition after about 1, 24, 48, 72, 168, 240 or about 336 hours post implantation.

The present disclosure is directed to a spinal fusion device comprising a biodegradable composition as disclosed herein; and a spinal fusion cage (e.g., peek cage), configured to retain the biodegradable calcium phosphate carrier.

Methods

The present disclosure is directed to a method of promoting healing of a long-bone fracture in a subject in need of such treatment, comprising: preparing a composition including a homodimeric protein as disclosed herein homogeneously entrained within a slow release biodegradable calcium phosphate carrier (e.g., β-TCP) that hardens so as to be impermeable to efflux of the homodimeric protein in vivo sufficiently that the long-bone fracture healing is confined to the volume of the calcium phosphate carrier; and implanting the composition at a location where the long-bone fracture occurs, wherein the homodimeric protein is in an amount of from about 0.03 mg/g to about 3.2 mg/g of the calcium phosphate carrier.

In certain embodiments, the method of promoting healing of a long-bone fracture further comprises gradually exposing the entrained homodimeric protein at the location as the calcium phosphate carrier degrades, wherein the calcium phosphate carrier has a calcium to phosphate ratio of about 0.4 to about 1.8.

The present disclosure is directed to a method for promoting spinal fusion, comprising: exposing an upper vertebra and a lower vertebra; identifying a site for fusion between the upper and the lower vertebra; exposing a bone surface on each of the upper and the lower vertebra at the site for fusion; and administering a homodimeric protein as disclosed herein and a biodegradable calcium phosphate carrier (e.g., β-TCP) to the site.

In certain embodiments, the biodegradable calcium phosphate carrier is a non-compressible delivery vehicle, and wherein the non-compressible delivery vehicle is for application to the site between the two bone surfaces where bone growth is desired but does not naturally occur.

In certain embodiments, the biodegradable calcium phosphate carrier comprises at least one implantation stick for application to the site such that the implantation stick extends lengthwise between the upper and the lower vertebrae.

In certain embodiments, the site is selected from a space between two adjacent vertebra bodies, and a space extending lengthwise between two adjacent transverse processes of two adjacent vertebrae.

The present disclosure is directed to a method for promoting arthrodesis, comprising administering a homodimeric protein as disclosed herein and a biodegradable calcium phosphate carrier to a malformed or degenerated joint.

In certain embodiments, administering the homodimeric protein includes administering from about 0.006 mg to about 10.5 mg of the homodimeric protein to the malformed or degenerated joint.

The present disclosure is directed to a method of generating a bone mass to fuse two adjacent vertebrae bodies in a spine of a subject in need, comprising: preparing a composition for generating the bone mass, the composition including a homodimeric protein as disclosed herein homogeneously entrained within a slow release biodegradable carrier that hardens so as to be impermeable to efflux of the homodimeric protein in vivo sufficiently that the formed bone mass is confined to the volume of the slow release biodegradable carrier; and introducing the composition in a location between the two adjacent vertebrae bodies, and wherein the slow release biodegradable carrier gradually exposes the entrained homodimeric protein at the location as the slow release biodegradable carrier degrades, and further wherein the homodimeric protein is in an amount of from about 0.2 mg/site to about 10.5 mg/site of the location.

In certain embodiments, the slow release biodegradable carrier has a porous structure, wherein cells from the two adjacent vertebrae migrate into the porous structure so as to generate the bone mass.

In certain embodiments, the slow release biodegradable carrier has an initial volume, and the bone mass replaces the initial volume of the slow release biodegradable carrier as the slow release biodegradable carrier is resorbed.

The present disclosure is directed to a method for fusing adjacent vertebrae bodies in a subject in need by a posterior or transforaminal fusion approach, comprising: preparing a disc space for receipt of an intervertebral disc implant in an intervertebral space between the adjacent vertebrae; introducing a slow-release carrier into the intervertebral disc implant, wherein a homodimeric protein as disclosed herein is in an amount of from about 0.2 mg/site to about 10.5 mg/site of the slow-release carrier; and introducing the intervertebral disc implant in the disc space between the adjacent vertebrae for generating a bone mass in the disc space.

The following examples are offered by way of illustration and not by way of limitation.

EXAMPLES Example 1: Plasmid Construction

For construction of plasmid pQE-80L-Kana, Kanamycin resistance gene was cleaved from pET-24a(+) (Novagen) by BspHI (BioLab) to generate a 875-bp Kanamycin resistance gene (+3886 to +4760) fragment (SEQ ID NO: 1). The pQE-80L (Qiagen) vector was digested with BspHI to remove Ampicillin resistance gene (+3587 to +4699) fragment (SEQ ID NO:2) and then the Kanamycin resistance gene fragment was ligated into the pQE-80L vector to generate a 4513-bp plasmid (pQE-80L-Kana). (SEQ ID NO:3)

Example 2: Yeast Two-Hybrid Screening

A. Construction of Bait Plasmid

Yeast two-hybrid screening was performed using a commercially available system (Matchmaker Two-Hybrid System 2; CLONTECH, Palo Alto, Calif.). To construct the bait plasmids, the coding region of the extracellular domain (+103 to +375 bp) (SEQ ID NO: 4) of activin receptor type IIB (ActRIIB) protein was produced by PCR with pCRII/ActRIIB (Hilden, et al. (1994) Blood 83(8):2163-70) as the template. The primers (XmaI: 5′-CCCGGGACGGGAGTGCATCTACAACG-3′(SEQ ID NO: 5); SalI: 5′-GTCGACTTATGGCAAATGAGTGAAGCGTTC-3′(SEQ ID NO: 6)) used to amplify the extracellular domain of ActRIIB (ActRIIBecd) were designed to include an XmaI and SalI restriction site in the 5′-end, respectively. PCR was carried out using 10 ng template DNA, 0.2 μM each primer, 0.2 mM each dNTP, 1×PCR buffer (10 mM Tris-HCl, pH 8.3, 50 mM KCl and 1.5 mM MgCl₂), and 1.25 U pfu DNA polymerase (Promega) in a total volume of 50 μl. PCR was performed with 30 cycles of: 30 seconds of denaturing at 95° C., followed by annealing at 45° C. for 1 min, and extension at 68° C. for 5 min. The PCR products were digested with XmaI-SalI and then subcloned in frame into the same restriction sites in the DNA-binding domain of GAL4 in the pAS2-1 vector (CLONTECH, GenBank Accession No.: U30497) to generate plasmid pAS-ActRIIBecd.

The nucleic acid sequences and polypeptide sequences of ActRIIB and naturally occurring variants are known. For example, a wild-type ActRIIB nucleic acid sequence is SEQ ID NO: 7. The corresponding polypeptide sequence is SEQ ID NO: 8. The extracellular domain of ActRIIB (ActRIIBecd) is SEQ ID NO: 9, which corresponds to residues 27-117 of SEQ ID NO: 8 and is encoded by the nucleic acid sequence of SEQ ID NO: 4.

B. Construction of pACT2/MC3T3 cDNA Library

To construct pACT2/MC3T3 cDNA library, approximately 7×10⁶ clones of a mouse MC3T3-E1 osteoblast cDNA library described by Tu Q., et al. (2003, J Bone Miner Res. 18(10):1825-33), with some modifications to allow cDNA library inserts smaller than 1.5 kb, were constructed into pACT2 vector (CLONTECH, GenBank Accession No.: U29899), wherein after 51 nuclease treatment (Invitrogen life technologies cDNA Synthesis System CAT. No. 18267-013), the double-stranded cDNA was cloned in the pACT2 vector, which had been digested with SmaI to express fusion proteins with the GAL4 activation domain. The pACT2/MC3T3 cDNA library was then screened by the “HIS3 Jump-Start” procedure according to the protocol from the manufacturer (CLONTECH, Palo Alto, Calif.). In another embodiment, the pACT2 cDNA library is obtained as a commercial product.

C. Selection of Yeast Strain

Saccharomyces cerevisiae Y190 cells (MATa, ura3-52, his3-D200, lys2-801, ade2-101, trp1-901, leu2-3, 112, gal4D, gal80D, URA3::GAL1_(UAS)-GAL1_(TATA)-lacZ, cyh^(r)2, LYS2::GAL_(UAS)-HIS3_(TATA)-HI53; CLONTECH, Palo Alto, Calif.) were first transformed with bait plasmids and selected on synthetic dextrose medium lacking tryptophan (SD-Trp). The transformants grown on the SD-Trp medium were subsequently transformed with the pACT2/MC3T3 cDNA library and selected on medium lacking tryptophan and leucine (SD-Trp-Leu). The clones co-transformed with the bait and library were collected and replated onto medium lacking tryptophan, leucine and histidine (SD-Trp-Leu-His) with 30 mM 3-amino-1,2,4-triazole (Sigma-Aldrich, St. Louis, Mo.) to inhibit the leaking growth of Y190 cells. The clones selected in this step were further assayed for their β-galactosidase activity. Plates were photo-graphed after incubation at 30° C. for 3 days. At least three independent experiments were performed, with similar results. The pACT2 library plasmids were purified from individual positive clones and amplified in Escherichia coli. Sequencing (primer 5′-AATACCACTACAATGGAT-3′ (SEQ ID NO: 10)) of the cDNA insert in the positive clones shown in Table 1 was performed with a Perkin-Elmer ABI Automated DNA Sequencer.

TABLE 1 Clone No./ SEQ ID No. DNA sequence Primers 1/SEQ ID 5′-GGCCAAGCCAAACGCAAAGGG 5′-TTAACCATGGGCCAAGCCAAACGC-3′ NO: 11 TATAAACGCCTTAAGTCCAAATGT (SEQ ID NO: 12) (The bold font  AACATACACCCTTTGTAC-3′ bases is the recognition site of restriction endonuclease MseI) 5′-GGATCCTTAGTACAAAGGGTGTATGTTAC-3′ (SEQ ID NO: 13) (The bold font  bases is the recognition site of restriction endonuclease BamHI) 2/SEQ ID 5′-GTGAGCTTCAAAGACATTGGG 5′-TTAACCATGGTGAGCTTCAAAGACA-3′ NO: 14 TGGAATGACCATGCTAGCAGCCAG (SEQ ID NO: 15) (The bold font  CCGGGGTATCACGCCCGTCCCTGC bases is the recognition site of CACGGACAATGCCAGAATATTCTG restriction endonuclease MseI) GCTGATCATCTGAACGAAGATTGT 5′-GGATCCTTAAACAGAGCGGGGCTTCAGCT-3′ CATGCCATTGTTCAGCTGAAGCCC (SEQ ID NO: 16) (The bold font  CGCTCTGTT-3′ bases is the recognition site of restriction endonuclease BamHI) 3/SEQ ID 5′-ATCGTTGTGGATAATAAGGCA 5′-TTAACCATGATCGTTGTGGATAATAAG-3′ NO: 17 TGCTGTGTCCCGACAGAACTCAGT (SEQ ID NO: 18) (The bold font  CTTCCCCATCCGCTGTACCTTGAC bases is the recognition site GAGAATAAAAAGCCTGTATATAAG of restriction endonuclease MseI) AACTATCAGGACGCGCTTCTGCAT 5′-GGATCCTTAGCGACACCCACAACTATGCA-3′ AGTTGTGGGTGTCGC-3′ (SEQ ID NO: 19) (The bold font  bases is the recognition site of restriction endonuclease BamHI) 4/SEQ ID 5′-ACGTATCCAGCCTCTCCGAAG 5′-TTAACCATGACGTATCCAGCCTCTCCG-3′ NO: 20 CCGATGAGGTGGTCAATGCGGAGC (SEQ ID NO: 21) (The bold font  TGCGCGTGCTGCGCCGGAGGTCTC bases is the recognition site of CGGAACCAGACAGGGACAGTG-3′ restriction endonuclease MseI) 5′-GGATCCTTACACTGTCCCTGTCTGGTTCC-3′ (SEQ ID NO: 22) (The bold font  bases is the recognition site of restriction endonuclease BamHI) 5/SEQ ID 5′-GAGCCCCTGGGCGGCGCGCGC 5′-TTAACCATGGAGCCCCTGGGCGGCGC-3′ NO: 23 TGGGAAGCGTTCGACGTGACGGAC (SEQ ID NO: 24) (The bold font  GCGGTGCAGAGCCACCGCCGCTGG bases is the recognition site of CCGCGAGCCTCCCGCAAGTGCTGC restriction endonuclease MseI) CTGGTGCTGCGCGCGGTGACGGCC 5′-GGATCCTTACGAGGCCGTCACCGCGCGCA-3′ TCG-3′ (SEQ ID NO: 25) (The bold font  bases is the recognition site of restriction endonuclease BamHI) 6/SEQ ID 5′-ACTGCGCTGGCTGGGACTCGG 5′-TTAACCATGACTGCGCTGGCTGGGAC-3′ NO: 26 GGAGCGCAGGGAAGCGGTGGTGGC (SEQ ID NO: 27) (The bold font  GGCGGTGGCGGTGGCGGCGGCGGC bases is the recognition site of GGCGGCGGCGGCGGCGGCGGCGGC restriction endonuclease MseI) GGCGCAGGCAGGGGCCACGGGCGC 5′-GGATCCTTAGCCCAGCTCCTTAAAGTCCA-3′ AGAGGCCGGAGCCGCTGCAGTCGC (SEQ ID NO: 28) (The bold font  AAGTCACTGCACGTGGACTTTAAG bases is the recognition site GAGCTGGGC-3′ of restriction endonuclease BamHI)

Example 3: Error-Prone Random Mutagenic PCR

A. Mutagenization with Primers Designed from Plasmid

The DNA sequences of positive clones from Example 2 were mutagenized.

In one embodiment, sequenced positive clones were subcloned into pQE-80L-Kana and then random mutageneic PCR was performed. The primers in Table 1 used to amplify DNA sequence of positive clones were designed to include a MseI or BamHI restriction site in the 5′-end. The PCR conditions were as described in Example 2. The PCR products were digested with MseI-BamHI and then subcloned in frame into the same restriction sites in the pQE-80L-Kana vector. Random mutagenesis was introduced into the subcloned pQE-80L-Kana plasmids on the basis of the error-prone PCR described by Leung et al. (1989, Technique, 1, 11-15), with some modifications. The linearized pQE-80L-Kana (XhoI-digested) was used as template DNA. The primers (MseI: 5′-GAATTCATTAAAGAGGAGAAATTAA (SEQ ID NO: 29); BamHI: 5′-CCGGGGTACCGAGCTCGCATGCGGATCCTTA (SEQ ID NO: 30)) used for mutagenic PCR amplification were designed to include a MseI or BamHI restriction site in the 5′-end, respectively. Mutagenic PCR was carried out using 10 ng template DNA, 40 pM each primer, 0.2 mM each dNTP, 1×PCR buffer (10 mM Tris-HCl, pH 8.3, 50 mM KCl and 1.5 mM MgCl₂), 0.2-0.3 mM MnCl₂, 1% dimethyl sulfoxide, and 1.25 U Taq DNA polymerase (Invitrogen, Carlsbad, Calif.) in a total volume of 50 μl. Mutagenic PCR was performed with 30 cycles of: 30 seconds of denaturing at 94° C., followed by annealing at 55° C. for 2 min, and extension at 72° C. for 3 min. The PCR product was digested by MseI and BamHI. This fragment was ligated with the 4.5-kb fragment of pQE-80L-Kana digested with MseI and BamHI. The resulting pQE-80L-Kana derivatives were used to transform E. coli BL21 (Novagen). Colonies were grown on a plate of LTB-agar medium (LB supplemented with 1% v/v tributyrin, 0.1% v/v Tween 80, 100 mg/L of kanamycin, 0.01 μM isopropyl β-D-thiogalactopyranoside, and 1.5% agar) at 37° C.

B. Mutagenization with Primers in TABLE I

In another embodiment, random mutagenesis was introduced into the pACT2 library plasmids from the positive clone on the basis of the error-prone PCR previously described by Leung with some modifications. The linearized pACT2 (XbaI-digested) was used as template DNA. Synthetic oligonucleotides with MseI and BamHI restriction sites shown in Table 1 were used primers for mutagenic PCR amplification. Mutagenic PCR was carried out using 10 ng template DNA, 40 pM each primer, 0.2 mM each dNTP, 1×PCR buffer (10 mM Tris-HCl, pH 8.3, 50 mM KCl and 1.5 mM MgCl₂), 0.2-0.3 mM MnCl₂, 1% dimethyl sulfoxide, and 1.25 U Taq DNA polymerase (Invitrogen, Carlsbad, Calif.) in a total volume of 50 μl. Mutagenic PCR was performed with 30 cycles of: 30 seconds of denaturing at 94° C., followed by annealing at 55° C. for 1.5 min, and extension at 72° C. for 4 min. The PCR product was digested by MseI and BamHI. This fragment was ligated with the 4.5-kb fragment of pQE-80L-Kana digested with MseI and BamHI. The resulting pQE-80L-Kana derivatives were used to transform E. coli BL21 (Novagen). Colonies were grown on a plate of LTB-agar medium (LB supplemented with 1% v/v tributyrin, 0.1% v/v Tween 80, 100 mg/L of kanamycin, 0.01 μM isopropyl β-D-thiogalactopyranoside, and 1.5% agar) at 37° C.

Example 4: Expression of ActRIIBecd-Associated Polypeptides

Stably transformed E. coli cells as described in Example 3 were used to express ActRIIBecd-associated polypeptides (i.e., “domains”) from the mutagenized DNA of Example 2.

A. Fermentation of Transformants

In one embodiment, overnight cultures (about 10 hrs) of E. coli BL21 transformants with pQE-80L-Kana derivatives in 500 mL Erlenmeyer flasks containing 65 mL of medium (10 g/L BBL PhytonePeptone, 5 g/L BactoYeast Extract, 10 g/L NaCl) with 25-32 μg/mL of kanamycin were grown at 30° C. to 37° and agitated with 180±20 rpm. 37-420 mL of the overnight cultures were added to 3.7-42 L of TB medium (BBL Phytone Peptone 18 g, Bacto yeast extract 36 g, KH₂PO₄ 18.81 g, Glycerol 6 mL in 1 L water) containing 23.8-38.5 μg/mL of kanamycin and 1-3 mmol/L isopropyl β-D-thiogalactopyranoside (IPTG) in 5-50 L fermentation tank and temperature control ranging from 37° C. to 42° C., and the culture media was agitated with 260-450 rpm for 10-24 hours. The cells were collected, in an ice water bath, after centrifugation for 10 minutes at 8,000 rpm in a GSA rotor (Sorvall).

In another embodiment, 1 L of LB liquid medium (with 100 mg/L of kanamycin) is inoculated with a freshly grown colony (E. coli BL21 transformants with pQE-80L-Kana derivatives) or 10 mL of freshly grown culture and incubated at 37° C. until OD₆₀₀ reaches 0.4-0.8. The expression of the polypeptides is induced by adding 40 or 400 μM IPTG for 3 to 5 hours at 37° C. After centrifugation (about 8,000 rpm), cells are collected at 4° C.

B. Recovery and Purification of Polypeptides from E. coli

E. coli BL21/pQE-80L-Kana derivatives cells were fermented as previously described in Example 4A. In one embodiment, cell disruption and recovery of polypeptides from those derivatives was performed at 4° C. About 18 g of wet cells were suspended in 60 mL of 0.1M TRIS/HCl, 10 mM EDTA (Ethylenediaminetetraacetic acid), 1 mM PMSF (Phenyl Methan Sulphonyl Fluoride), pH 8.3 (disruption buffer). The cells were passed two times through a Frenchpress (SLM Instruments, Inc.) according to the manufacturer's instructions and the volume was brought to 200 mL with the disruption buffer. The suspension was centrifuged for 20 min at 15,000 g. The pellet obtained was suspended in 100 mL disruption buffer containing 1M NaCl and centrifuged for 10 min as above. The pellet was suspended in 100 mL disruption buffer containing 1% Triton X-100 (Pierce) and again centrifuged for 10 min as above. The washed pellet was then suspended in 50 mL of 20 mM Tris/HCl, 1 mM EDTA, 1 mM PMSF, 1% DTT (Dithiothreitol) and homogenised in a Teflon tissue grinder. The resulting suspension contained crude polypeptides in a non-soluble form.

10 mL of the polypeptide suspension obtained according to previous embodiment were acidified with 10% acetic acid to pH 2.5 and centrifuged in an Eppendorf centrifuge for 10 min at room temperature. The supernatant was chromatographed on a Sephacryl S-100 column (Pharmacia, 2.6×78 cm) in 10% acetic acid at a flow rate of 1.4 mL/min. Fractions containing polypeptide eluting between appropriate time periods were pooled. This material was used for refolding to get biologically active polypeptides or for further purification.

5 mg of polypeptide from previous embodiment was dissolved in 140 mL 50 mM Tris/HCl pH 8.0, 1M NaCl, 5 mM EDTA, 2 mM reduced glutathione, 1 mM oxidised glutathione and 33 mM Chaps (Calbiochem). After 72 hours at 4° C., the pH of the solution was adjusted to pH 2.5 with HCl and the mixture was concentrated 10 times by ultrafiltration on a YM 10 membrane (Amicon, Danvers, Mass., USA) in an Amicon stirred cell. The concentrated solution was diluted to the original volume with 10 mM HCl and concentrated to a final volume of 10 mL by the same method. The precipitate formed was removed by centrifugation at 5000 g for 30 minutes. The supernatant contained disulfide linked polypeptide as judged by SDS-PAGE under non-reducing conditions. The biological activity of the preparation was measured by BIAcore™ assay (Example 5).

The concentrated solution from the previous embodiment was applied at a flow rate of 1 mL/min onto a Mono S HR 5/5 column (Pharmacia) equilibrated in a mixture of 85% buffer A (20 mM sodium acetate, 30% isopropanol, pH 4.0) and 15% buffer B (buffer A containing 1M sodium chloride). The column was then washed at the same flow rate keeping the buffer mixture composition constant until the absorbance reading at 280 nm has reached baseline level, followed by a linear gradient over 20 minutes starting upon injection at the equilibration conditions and ending with a mixture of 50% buffer A/50% buffer B. The biologically active polypeptide was eluted about 9 minutes after the start of the gradient and collected. As judged by biological activity determination, and SDS-PAGE under non-reducing conditions.

In another embodiment, the polypeptides are prepared from inclusion bodies of collected cells in Example 4A. After extraction (50 mM sodium acetate, pH 5, 8 M urea, 14 mM 2-mercaptoethanol) at room temperature overnight and exhaustive dialysis against water, the polypeptides are refolded, concentrated and enriched by Sephacryl S-100 HR column (Pharmacia) in 1% acetic acid or 5 mM HCl at a flow rate of 1.8 mL/min. It is finally purified by FPLC (Fractogel EMD SO₃ ⁻ 650, 50 mM sodium acetate, pH 5, 30% 2-propanol) eluting with a NaCl gradient from 0 to 1.5 M. Fractions containing polypeptide eluting between appropriate time periods are pooled. After dialysis against water, the polypeptides are freeze/dried and stored at −20° C. The purity of the polypeptides is analyzed by SDS-PAGE, followed by staining with Coomassie Brilliant Blue R.

In other embodiment, each 1 gram of cell pellet, derived for example from the above Example 4A, was resuspended in 10-20 mL of 10 mM TRIS/HCl, 150 mM NaCl, 1 mM EDTA, 5 mM DTT, pH 8.0 (disruption buffer), and the cells burst by sonication, using a Misonix 54000 instrument, with a Enhance Booster #1 probe, at 30 A (instrument scale) for 5 minutes. Optionally, the cell lysate mixture was clarified by centrifugation (either 18,000×g for 20 min or 15,000×g for 30 min) and the pellet was washed several times with 10-20 mL disruption buffer containing 1 v/v % Triton X-100 and centrifuged for 10 min as above. The cell lysate was dissolved with 100-200 mL disruption buffer containing 6 M urea and centrifuged for 10 min as above and the supernatant containing the polypeptides was retained for further purification.

The previous mentioned supernatant was dissolved in refolding buffer (100 mL Tris/HCl pH 8.0, 500 mM Arginine-HCl, 5 mM EDTA, 25 mM Chaps, 2 mM oxidised glutathione and 1 mM reduced glutathione). After 4-7 days at room temperature, the polypeptides were purified by FPLC (Fractogel EMD SO₃ ⁻ 650, 20 mM sodium acetate, pH 4-5, 30% 2-propanol and 25 mM Chaps) eluting with a NaCl gradient from 0 to 3 M. Fractions containing polypeptide eluting between appropriate time periods were pooled. The purity of the polypeptides was analyzed by SDS-PAGE, followed by staining with Coomassie Brilliant Blue R.

In certain embodiments, the heterodimers of the present disclosure can be prepared by co-expression in a transient expression system as previously mentioned in Example 3 and the heterodimers can be isolated from the culture medium for screening in the assays of Example 5.

Example 5: In Vitro BIAcore™ Assay

Biosensor experiments. In one embodiment, experiments were performed on a BIAcore™ T100/T200 instrument (Pharmacia Biosensor AB) in the multichannel mode (serial flow path involving flow cells 1+2+3+4). Flow rate was 10 μl/min; temperature was 25° C.; and data were recorded at 2.5 points/s. All four segments of a sensor chip CM5 were coated with streptavidin (Sigma) to a density of 2000 pg/mm² (2000 resonance units) by the aminocoupling procedure. ActRIIBecd (10 mg) and amine-PEG3-Biotin (10 mg, Pierce, Rockford, Ill.) were dissolved in 200 μl H₂O and 10 mg NaCNBH₃ was added to prepare biotinylated ActRIIBecd. The reaction mixture was heated at 70° C. for 24 h, after that a further 10 mg NaCNBH₃ was added and the reaction was heated at 70° C. for another 24 h. After cooling to room temperature, the mixture was desalted with the spin column (3,000 molecular weight cut off (MWCO)). Biotinylated ActRIIBecd was collected, freeze-dried and used for streptavidin (SA) chip preparation. Amino-biotinylated ActRIIBecd was then immobilized independently on flow cells 2-4 for 10 minutes at a flow rate of 5 μL/min and a concentration of 20 μM in 10 mM sodium acetate, pH 4.0, at a density of 50-250 resonance units (RU). The stored polypeptides were dissolved in glycine buffer (2.5 g of glycine, 0.5 g of sucrose, 370 mg of L-glutamate, 10 mg of sodium chloride, and 10 mg of Tween 80 in 100 mL water, pH 4.5) to prepare 10 mg/mL solution and then diluted with previous glycine buffer to prepare analytes with various concentration. Sensograms were recorded during flow of the analyte (the ActRIIBecd-associated polypeptides (i.e., domains) as previously described) first through flow cell 1 (control) then through flow cell 2 (biotinylated ActRIIBecd). The sensogram obtained for flow cell 1 was subtracted from the sensogram obtained for flow cell 2. The sensograms obtained at 1.11, 3.33, 10, 30, and 90 nM analyte were evaluated for equilibrium binding, association rate, and dissociation rate by using the programs supplied with the instrument (BIA evaluation 2.1; Software Handbook. 1995; Pharmacia Biosensor AB). Analytes and bovine serum albumin (negative control) were listed in Table 2. Sequencing (primer 5′-CTCGAGAAAT CATAAAAAAT TTATTTG-3′ (SEQ ID NO: 31)) of the pQE-80L-Kana derivatives in the clone related to analyte, which has a higher affinity constant than that of albumin, was performed with a Perkin-Elmer ABI Automated DNA Sequencer as previously described.

TABLE 2 Clone Affinity constant No. DNA sequence Domain sequence Mean_([nM]) SD_([nM])  7 5′-GCTCAAGCCAAACA AQAKHKGYKRLKSNCKR NB CAAAGGGTATAAACGCC HPLY TTAAGTCCAATTGTAAA (SEQ ID NO: 33) AGGCACCCTTTGTAC-3′ (SEQ ID NO: 32)  8 5′-GGCCAAGCCAAACG GQAKRKGYKRLKSSCKR 45.12  ±15.39 CAAAGGGTATAAACGCC HPLY TTAAGTCCAGCTGTAAG (SEQ ID NO: 35) AGACACCCTTTGTAC-3′ (SEQ ID NO: 34)  9 5′-GCCCAAGCCAAACA AQAKHKGYKRLKSSCKR 52.41  ±16.71 TAAAGGGTATAAACGCC HPLY TTAAGTCCAGCTGTAAG (SEQ ID NO: 37) AGACACCCTTTGTAC-3′ (SEQ ID NO: 36) 10 5′-GCTCAAGCCAAACA AQAKHKQRKRLKSSCKR 36.39 ±12.12 CAAACAGCGGAAACGCC HPLY TTAAGTCCAGCTGTAAG (SEQ ID NO: 39) AGACACCCTTTGTAC-3′ (SEQ ID NO: 38) 11 5′-GCTCAAGCCAAACA AQAKHKGRKRLKSSCKR 63.72  ±23.17 CAAAGGTCGGAAACGCC HPLY TTAAGTCCAGCTGTAAG (SEQ ID NO: 41) AGACACCCTTTGTAC-3′ (SEQ ID NO: 40) 12 5′-GCTCAAGCCAAACA AQAKHKQYKRLKSSCKR 58.42 ±24.42 CAAACAGTACAAACGCC HPLY TTAAGTCCAGCTGTAAG (SEQ ID NO: 43) AGACACCCTTTGTAC-3′ (SEQ ID NO: 42) 13 5′-GTGGATTTCAAGGA VDFKDVGWNDHAVAPPG NB CGTTGGGTGGAATGACC YHAFYCHGECPHPLADH ATGCTGTGGCACCGCCG LNSDNHAIVQTKVNSV GGGTATCACGCCTTCTA (SEQ ID NO: 45) TTGCCACGGAGAATGCC CGCATCCACTGGCTGAT CATCTGAACTCAGATAA CCATGCCATTGTTCAGA CCAAGGTTAATTCTGTT- 3′ (SEQ ID NO: 44) 14 5′-GTGGATTTCAAGGA VDFKDVGWNDHAVAPPG 38.32  ±12.79 CGTTGGGTGGAATGACC YHAFYCHGECPFPLADH ATGCTGTGGCACCGCCG LNSDNHAIVQTKVNSV GGGTATCACGCCTTCTA (SEQ ID NO: 47) TTGCCACGGAGAATGCC CGTTCCCACTGGCTGAT CATCTGAACTCAGATAA CCATGCCATTGTTCAGA CCAAGGTTAATTCTGTT- 3′ (SEQ ID NO: 46) 15 5′-GTGGACTTCAGTGA VDFSDVGWNDWIVAPPG 39.45  ±14.11 CGTGGGGTGGAATGACT YHAFYCHGECPFPLADH GGATTGTGGCTCCCCCG LNSTNHAIVQTLVNSV GGGTATCACGCCTTTTA (SEQ ID NO: 49) CTGCCACGGAGAATGCC CTTTTCCTCTGGCTGAT CATCTGAACTCCACTAA TCATGCCATTGTTCAGA CGTTGGTCAACTCTGTT- 3′ (SEQ ID NO: 48) 16 5′-GTGGATTTCAGCGA VDFSDVGWNDWAVAPPG 55.98 ±18.12 CGTTGGGTGGAATGACT YHAFYCHGECPFPLADH GGGCTGTGGCACCGCCG LNSDNHAIVQTLVNSV GGGTATCACGCCTTCTA (SEQ ID NO: 51) TTGCCACGGAGAATGCC CGTTCCCACTGGCTGAT CATCTGAACTCAGATAA CCATGCCATTGTTCAGA CCCTCGTTAATTCTGTT- 3′ (SEQ ID NO: 50) 17 5′-GTGGATTTCAGCGA VDFSDVGWNDWIVAPPG 67.42 ±17.89 CGTTGGGTGGAATGACT YHAFYCHGECPFPLADH GGATCGTGGCACCGCCG LNSDNHAIVQTLVNSV GGGTATCACGCCTTCTA (SEQ ID NO: 53) TTGCCACGGAGAATGCC CGTTCCCACTGGCTGAT CATCTGAACTCAGATAA CCATGCCATTGTTCAGA CCCTCGTTAATTCTGTT- 3′ (SEQ ID NO: 52) 18 5′-GTGGATTTCTCTGA VDFSDVGWNDHAVAPPG 64.12 ±16.78 CGTTGGGTGGAATGACC YHAFYCHGECPFPLADH ATGCTGTGGCACCGCCG LNSTNHAIVQTLVNSV GGGTATCACGCCTTCTA (SEQ ID NO: 55) TTGCCACGGAGAATGCC CGTTCCCACTGGCTGAT CATCTGAACTCAACGAA CCATGCCATTGTTCAGA CCCTTGTTAATTCTGTT- 3′ (SEQ ID NO: 54) 19 5′-AATAGCAAAGATCC NSKDPKACCVPTELSAP 40.12 ±13.69 CAAGGCATGCTGTGTCC SPLYLDENEKPVLKNYQ CGACAGAACTCAGTGCC DMVVHGCGCR CCCAGCCCGCTGTACCT (SEQ ID NO: 57) TGACGAGAATGAGAAGC CTGTACTCAAGAACTAT CAGGACATGGTAGTCCA TGGGTGTGGGTGTCGC- 3′ (SEQ ID NO: 56) 20 5′-AATAGCAAAATCCC NSKIPKACCQPTELSAP NB CAAGGCATGCTGTCAGC SPLYLDENEKPVLKNYQ CGACAGAACTCAGTGCC DMVVEGCGCR CCCAGCCCGCTGTACCT (SEQ ID NO: 59) TGACGAGAATGAGAAGC CTGTACTCAAGAACTAT CAGGACATGGTAGTCGA AGGGTGTGGGTGTCGC- 3′ (SEQ ID NO: 58) 21 5′-AACTCTAAGATTCC NSKIPKACCVPTELSAI 37.12 ±11.88 TAAGGCATGCTGTGTCC  SMLYLDENEKVVLKNYQ CGACAGAACTCAGTGCT DMVVEGCGCR ATCTCGATGCTGTACCT (SEQ ID NO: 61) TGACGAGAATGAAAAGG TTGTATTAAAGAACTAT CAGGACATGGTTGTGGA GGGTTGTGGGTGTCGC- 3′ (SEQ ID NO: 60) 22 5′-AATAGCAAAATCCC NSKIPKACCVPTELSAI 51.72 ±18.52 CAAGGCATGCTGTGTCC SPLYLDENEKVVLKNYQ CGACAGAACTCAGTGCC DMVVHGCGCR ATAAGCCCGCTGTACCT (SEQ ID NO: 63) TGACGAGAATGAGAAGG TCGTACTCAAGAACTAT CAGGACATGGTAGTCCA TGGGTGTGGGTGTCGC- 3′ (SEQ ID NO: 62) 23 5′-AATAGCAAAATACC NSKIPKACCVPTELSAI 64.41 ±17.42 CAAGGCATGCTGTGTCC SMLYLDENEKPVLKNYQ CGACAGAACTCAGTGCC DMVVEGCGCR ATTAGCATGCTGTACCT (SEQ ID NO: 65) TGACGAGAATGAGAAGC CTGTACTCAAGAACTAT CAGGACATGGTAGTCGA AGGGTGTGGGTGTCGC- 3′ (SEQ ID NO: 64) 24 5′-AATAGCAAAGATCC NSKDPKACCVPTELSAI 56.74 ±13.59 CAAGGCATGCTGTGTCC SMLYLDENEKVVLKNYQ CGACAGAACTCAGTGCC DMVVHGCGCR ATAAGCATGCTGTACCT (SEQ ID NO: 67) TGACGAGAATGAGAAGG TGGTACTCAAGAACTAT CAGGACATGGTAGTCCA TGGGTGTGGGTGTCGC- 3′ (SEQ ID NO: 66) 25 5′-ACGTATCCAGCCTC TYPASPKPMRHKMRSCA 41.09 ±14.15 TCCGAAGCCGATGAGGC CCAGGLRNRTGTV ATAAAATGCGGAGCTGC (SEQ ID NO: 69) GCGTGCTGCGCCGGAGG TCTCCGGAACCGAACAG GGACAGTG-3′ (SEQ ID NO: 68) 26 5′-ACGTATCCCGCCTC TYPASPKPMRHSMRSCA 39.58 ±16.14 TCCGAAGCCGATGAGGC CCAGGLRNQTGTV ATTCAATGCGGAGCTGC (SEQ ID NO: 71) GCGTGCTGCGCCGGAGG TCTCCGGAACCAGACAG GGACAGTG-3′ (SEQ ID NO: 70) 27 5′-ACGTATCCAGCCTC TYPASPKPMRWKMRSCA 49.33  ±14.11 TCCGAAGCCGATGAGGT CCAGGLRNRTGTV GGAAGATGCGGAGCTGC (SEQ ID NO: 73) GCGTGCTGCGCCGGAGG TCTCCGGAACCGGACAG GGACAGTG-3′ (SEQ ID NO: 72) 28 5′-GAGCCCCTGGGCGG EPLGGARWEAFDVTDAV 53.78  ±14.42 CGCGCGCTGGGAAGCGT QSHRRSPRASRKCCLGL TCGACGTGACGGACGCG RAVTAS GTGCAGAGCCACCGCCG (SEQ ID NO: 75) CTCGCCACGAGCCTCCC GCAAGTGCTGCCTGGGG CTGCGCGCGGTGACGGC CTCG-3′ (SEQ ID NO: 74) 29 5′-GAGCCCCTGGGCGG EPLGGARWEAFDVTDAV 57.89 ±13.44 CGCGCGCTGGGAAGCGT QSHRRSQRASRKCCLVL TCGACGTGACGGACGCG RAVTAS GTGCAGAGCCACCGCCG (SEQ ID NO: 77) CTCGCAGCGAGCCTCCC GCAAGTGCTGCCTGGTT CTGCGCGCGGTGACGGC CTCG-3′ (SEQ ID NO: 76) 30 5′-ACCGCCCTAGATGG TALDGTRGAQGSGGGGG 61.74 ±16.41 GACTCGGGGAGCGCAGG GGGGGGGGGGGGGGGAG GAAGCGGTGGTGGCGGC RGHGRRGRSRCSRKSLH GGTGGCGGTGGCGGCGG VDFKELG CGGCGGCGGCGGCGGCG (SEQ ID NO: 355) GCGGCGGCGGCGGCGCA GGCAGGGGCCACGGGCG CAGAGGCCGGAGCCGCT GCAGTCGCAAGTCACTG CACGTGGACTTTAAGGA GCTGGGC-3′ (SEQ ID NO: 78) NB: Binding is below detection limit (KD > 1 mM)

Example 6: Production of Recombinant Polypeptides

To determine whether affinity constants could be enhanced, the individual domains in Table 2 were fused with one another to produce recombinant polypeptides using the PCR-Fusion procedure described by Atanassov et al. (2009, Plant Methods, 5:14), with some modifications. PCR-fusion was carried out using Phusion DNA polymerase (Finnzymes; Finland) and a standard thermal cycler. Gateway recombination reactions were performed with BP Clonase II and LR Clonase II enzyme mixes (Invitrogen). Competent E. coli DH5a cells, were prepared according to Nojima et al. (1990, Gene, 96 (1): 23-28). Plasmid DNA and PCR fragments were purified using QIAprep® Spin Miniprep Kit and QIAquick® Gel Extraction and PCR purification kits (Qiagen, Germany).

DNA template(s), PCR primers, and the DNA/polypeptide sequences of the resultant recombinant polypeptides are provided in Table 3. PCR-fusion involves two or three parallel PCR amplifications from plasmid template(s). PCR fusion of the amplified fragments through a single overlap extension was carried out on gel purified PCR fragments from these parallel reactions. Cycling parameters were identical for all PCR amplifications in this manuscript using reaction mix and conditions according to Phusion DNA polymerase guidelines (NewEnglandBiolabs: Phusion™ High-Fidelity DNA Polymerase. Manual). Annealing temperatures from plasmid templates were 55° C.

For fusion of two PCR fragments, 30 μl overlap extension reactions were used, which contained: 16 μl mixture of the two PCR fragments (normally 8 μl for each one; approx. 200-800 ng, DNA), 6 μl of 5× Phusion HF Buffer, 3 μl of 2 mM dNTP mix, 0.3 μl of Phusion™ DNA Polymerase (2 U/μl). No primers were added to the overlap extension mixture. When three DNA fragments were fused, an 18 μl mixture of the PCR fragments (normally 6 μl for each one) was used. Generally, equal volumes of purified PCR fragments were used without checking exact DNA concentrations. If the molar ratios of the amplified PCR fragments appeared to differ substantially (e.g., by more than 5-7 fold, following estimation of DNA band intensities after agarose electrophoresis), volumes from purified PCR fragments were adjusted accordingly. The reaction mix was incubated at 98° C. for 30 sec., 60° C. for 1 min and 72° C. for 7 min. DNA obtained after the overlap extension reaction was purified using a PCR purification kit. PCR products were digested and coned in the pQE-80L-Kana vector for protein/polypeptide expression as previously described. The affinity of purified protein/polypeptide to ActRIIBecd was monitored by previously discussed BIAcore™ T100/T200 (GE Healthcare) and the data were analyzed by using BIAevaluation software ver. 4.1 (GE Healthcare) in Example 5.

TABLE 3 Clone No. for DNA sequence/ Recombinant Affinity constant Template Polypeptide sequence Primers Mean[nm] SD[nm]  9 + 11 5′- First pair: 59.11 ±19.71 GCCCAAGCCAAACATAA 5′- AGGGTATAAACGCCTTA TTAACCATGGCCCA AGTCCAGCTGTAAGAGA AGCCAAACAT-3′ CACCCTTTGTACGCTCAA (SEQ ID NO: 81) GCCAAACACAAAGGTCG 5′- GAAACGCCTTAAGTCCA GTTTGGCTTGAGCGT GCTGTAAGAGACACCCT ACAAAGGGTG-3′ TTGTAC-3′ (SEQ ID NO: (SEQ ID NO: 82) 79)/ Second pair: AQAKHKGYKRLKSSCKR 5′- HPLYAQAKHKGRKRLKS CACCCTTTGTACGCT SCKRHPLY (SEQ ID NO: CAAGCCAAAC-3′ 80) (SEQ ID NO: 83) 5′- GGATCCTTAGTACA AAGGGTGTCTC-3′ (SEQ ID NO: 84) 11 + 9 5′- First pair: 58.22 ±18.15 GCTCAAGCCAAACACAA 5′- AGGTCGGAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACA-3′ CACCCTTTGTACGCCCA (SEQ ID NO: 87) AGCCAAACATAAAGGGT 5′- ATAAACGCCTTAAGTCC GTTTGGCTTGGGCGT AGCTGTAAGAGACACCC ACAAAGGGTG-3′ TTTGTAC-3′ (SEQ ID NO: (SEQ ID NO: 88) 85)/ Second pair: AQAKHKGRKRLKSSCKR 5′- HPLYAQAKHKGYKRLKS CACCCTTTGTACGCC SCKRHPLY (SEQ ID NO: CAAGCCAAAC-3′ 86) (SEQ ID NO: 89) 5′- GGATCCTTAGTACA AAGGGTGTCTC-3′ (SEQ ID NO: 90) 17 + 18 5′- First pair: 65.77 ±19.56 GTGGATTTCAGCGACGT 5′- TGGGTGGAATGACTGGA TTAACCATGGTGGAT TCGTGGCACCGCCGGGG TTCAGCGACG-3′ (SEQ TATCACGCCTTCTATTGC ID NO: 93) CACGGAGAATGCCCGTT 5′- CCCACTGGCTGATCATCT CAGAGAAATCCACA GAACTCAGATAACCATG ACAGAATTAAC-3′ CCATTGTTCAGACCCTCG (SEQ ID NO: 94) TTAATTCTGTTGTGGATT Second pair: TCTCTGACGTTGGGTGG 5′- AATGACCATGCTGTGGC GTTAATTCTGTTGTG ACCGCCGGGGTATCACG GATTTCTCTG-3′ (SEQ CCTTCTATTGCCACGGA ID NO:95) GAATGCCCGTTCCCACT 5′- GGCTGATCATCTGAACT GGATCCTTAAACAG CAACGAACCATGCCATT AATTAACAAGG-3′ GTTCAGACCCTTGTTAAT (SEQ ID NO: 96) TCTGTT-3′ (SEQ ID NO: 91)/ VDFSDVGWNDWIVAPPG YHAFYCHGECPFPLADHL NSDNHAIVQTLVNSVVDF SDVGWNDHAVAPPGYHA FYCHGECPFPLADHLNST NHAIVQTLVNSV (SEQ ID NO: 92) 18 + 17 5′- First pair: 66.38 ±16.41 GTGGATTTCTCTGACGTT 5′- GGGTGGAATGACCATGC TTAACCATGGTGGAT TGTGGCACCGCCGGGGT TTCTCTGACG-3′ (SEQ ATCACGCCTTCTATTGCC ID NO: 99) ACGGAGAATGCCCGTTC 5′- CCACTGGCTGATCATCT CGCTGAAATCCACA GAACTCAACGAACCATG ACAGAATTAAC-3′ CCATTGTTCAGACCCTTG (SEQ ID NO: 100) TTAATTCTGTTGTGGATT Second pair: TCAGCGACGTTGGGTGG 5′- AATGACTGGATCGTGGC GTTAATTCTGTTGTG ACCGCCGGGGTATCACG GATTTCAGCG-3′ CCTTCTATTGCCACGGA (SEQ ID NO: 101) GAATGCCCGTTCCCACT 5′- GGCTGATCATCTGAACT GGATCCTTAAACAG CAGATAACCATGCCATT AATTAACGAGG-3′ GTTCAGACCCTCGTTAAT (SEQ ID NO: 102) TCTGTT-3′ (SEQ ID NO: 97)/ VDFSDVGWNDHAVAPPG YHAFYCHGECPFPLADHL NSTNHAIVQTLVNSVVDF SDVGWNDWIVAPPGYHA FYCHGECPFPLADHLNSD NHAIVQTLVNSV (SEQ ID NO: 98) 23 + 24 5′- First pair: 61.77 ±15.74 AATAGCAAAATACCCAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAATAG CAGAACTCAGTGCCATT CAAAATACCCA-3′ AGCATGCTGTACCTTGA (SEQ ID NO: 105) CGAGAATGAGAAGCCTG 5′- TACTCAAGAACTATCAG GATCTTTGCTATTGC GACATGGTAGTCGAAGG GACACCCACAC-3′ GTGTGGGTGTCGCAATA (SEQ ID NO: 106) GCAAAGATCCCAAGGCA Second pair: TGCTGTGTCCCGACAGA 5′- ACTCAGTGCCATAAGCA GTGTGGGTGTCGCAA TGCTGTACCTTGACGAG TAGCAAAGATC-3′ AATGAGAAGGTGGTACT (SEQ ID NO: 107) CAAGAACTATCAGGACA 5′- TGGTAGTCCATGGGTGT GGATCCTTACGACA GGGTGTCGC-3′ (SEQ ID CCCACACCCAT-3′ NO: 103)/ (SEQ ID NO: 108) NSKIPKACCVPTELSAISM LYLDENEKPVLKNYQDM VVEGCGCRNSKDPKACC VPTELSAISMLYLDENEK VVLKNYQDMVVHGCGC R (SEQ ID NO: 104) 24 + 23 5′- First pair: 62.74 ±17.84 AATAGCAAAGATCCCAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAATAG CAGAACTCAGTGCCATA CAAAGATCCCA-3′ AGCATGCTGTACCTTGA (SEQ ID NO: 111) CGAGAATGAGAAGGTGG 5′- TACTCAAGAACTATCAG GTATTTTGCTATTGC GACATGGTAGTCCATGG GACACCCACAC-3′ GTGTGGGTGTCGCAATA (SEQ ID NO: 112) GCAAAATACCCAAGGCA Second pair: TGCTGTGTCCCGACAGA 5′- ACTCAGTGCCATTAGCA GTGTGGGTGTCGCAA TGCTGTACCTTGACGAG TAGCAAAATAC-3′ AATGAGAAGCCTGTACT (SEQ ID NO: 113) CAAGAACTATCAGGACA 5′- TGGTAGTCGAAGGGTGT GGATCCTTAGCGAC GGGTGTCGC-3′ (SEQ ID ACCCACACCCT-3′ NO: 109)/ (SEQ ID NO: 114) NSKDPKACCVPTELSAIS MLYLDENEKVVLKNYQD MVVHGCGCRNSKIPKAC CVPTELSAISMLYLDENE KPVLKNYQDMVVEGCGC R (SEQ ID NO: 110) 12 + 25 5′- First pair: 51.21 ±12.34 GCTCAAGCCAAACACAA 5′- ACAGTACAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACAA-3′ CACCCTTTGTACACGTAT (SEQ ID NO: 117) CCAGCCTCTCCGAAGCC 5′- GATGAGGCATAAAATGC GAGGCTGGATACGT GGAGCTGCGCGTGCTGC GTACAAAGGGTG-3′ GCCGGAGGTCTCCGGAA (SEQ ID NO: 118) CCGAACAGGGACAGTG- Second pair: 3′ (SEQ ID NO: 115)/ 5′- AQAKHKQYKRLKSSCKR CACCCTTTGTACACG HPLYTYPASPKPMRHKM TATCCAGCCTC-3′ RSCACCAGGLRNRTGTV (SEQ ID NO:119) (SEQ ID NO: 116) 5′- GGATCCTTACACTG TCCCTGTTCGG-3′ (SEQ ID NO: 120) 25 + 12 5′- First pair: NB ACGTATCCAGCCTCTCC 5′- GAAGCCGATGAGGCATA TTAACCATGACGTAT AAATGCGGAGCTGCGCG CCAGCCTCTCC-3′ TGCTGCGCCGGAGGTCT (SEQ ID NO: 123) CCGGAACCGAACAGGGA 5′- CAGTGGCTCAAGCCAAA GTTTGGCTTGAGCCA CACAAACAGTACAAACG CTGTCCCTGTTC-3′ CCTTAAGTCCAGCTGTA (SEQ ID NO: 124) AGAGACACCCTTTGTAC- Second pair: 3′ (SEQ ID NO: 121)/ 5′- TYPASPKPMRHKMRSCA GAACAGGGACAGTG CCAGGLRNRTGTVAQAK GCTCAAGCCAAAC-3′ HKQYKRLKSSCKRHPLY (SEQ ID NO: 125) (SEQ ID NO: 122) 5′- GGATCCTTAGTACA AAGGGTGTCTC-3′ (SEQ ID NO: 126) 16 + 26 5′- First pair: 57.78 ±19.11 GTGGATTTCAGCGACGT 5′- TGGGTGGAATGACTGGG TTAACCATGGTGGAT CTGTGGCACCGCCGGGG TTCAGCGACG-3′ (SEQ TATCACGCCTTCTATTGC ID NO: 129) CACGGAGAATGCCCGTT 5′- CCCACTGGCTGATCATCT GGCGGGATACGTAA GAACTCAGATAACCATG CAGAATTAACG-3′ CCATTGTTCAGACCCTCG (SEQ ID NO: 130) TTAATTCTGTTACGTATC Second pair: CCGCCTCTCCGAAGCCG 5′- ATGAGGCATTCAATGCG CGTTAATTCTGTTAC GAGCTGCGCGTGCTGCG GTATCCCGCC-3′ (SEQ CCGGAGGTCTCCGGAAC ID NO: 131) CAGACAGGGACAGTG-3′ 5′- (SEQ ID NO: 127)/ GGATCCTTACACTG VDFSDVGWNDWAVAPP TCCCTGTCTGG-3′ GYHAFYCHGECPFPLADH (SEQ ID NO: 132) LNSDNHAIVQTLVNSVTY PASPKPMRHSMRSCACCA GGLRNQTGTV (SEQ ID NO: 128) 26 + 16 5′- First pair: 61.74 ±13.69 ACGTATCCCGCCTCTCCG 5′- AAGCCGATGAGGCATTC TTAACCATGACGTAT AATGCGGAGCTGCGCGT CCCGCCTCTCC-3′ GCTGCGCCGGAGGTCTC (SEQ ID NO: 135) CGGAACCAGACAGGGAC 5′- AGTGGTGGATTTCAGCG CGCTGAAATCCACCA ACGTTGGGTGGAATGAC CTGTCCCTGTC-3′ TGGGCTGTGGCACCGCC (SEQ ID NO: 136) GGGGTATCACGCCTTCT Second pair: ATTGCCACGGAGAATGC 5′- CCGTTCCCACTGGCTGAT GACAGGGACAGTGG CATCTGAACTCAGATAA TGGATTTCAGCG-3′ CCATGCCATTGTTCAGA (SEQ ID NO: 137) CCCTCGTTAATTCTGTT- 5′- 3′ (SEQ ID NO: 133)/ GGATCCTTAAACAG TYPASPKPMRHSMRSCAC AATTAACGAGGG-3′ CAGGLRNQTGTVVDFSD (SEQ ID NO: 138) VGWNDWAVAPPGYHAF YCHGECPFPLADHLNSDN HAIVQTLVNSV (SEQ ID NO: 134) 12 + 28 5′- First pair: 59.14 ±16.11 GCTCAAGCCAAACACAA 5′- ACAGTACAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACAAAC-3′ CACCCTTTGTACGAGCC (SEQ ID NO: 141) CCTGGGCGGCGCGCGCT 5′- GGGAAGCGTTCGACGTG CCGCCCAGGGGCTC ACGGACGCGGTGCAGAG GTACAAAGGGTGTC- CCACCGCCGCTCGCCAC 3′ (SEQ ID NO: 142) GAGCCTCCCGCAAGTGC Second pair: TGCCTGGGGCTGCGCGC 5′- GGTGACGGCCTCG-3′ GACACCCTTTGTACG (SEQ ID NO: 139)/ AGCCCCTGGGCGG-3′ AQAKHKQYKRLKSSCKR (SEQ ID NO: 143) HPLYEPLGGARWEAFDV 5′- TDAVQSHRRSPRASRKCC GGATCCTTACGAGG LGLRAVTAS (SEQ ID NO: CCGTCACCGCGCGC- 140) 3′ (SEQ ID NO: 144) 28 + 12 5′- First pair: 57.89 ±18.67 GAGCCCCTGGGCGGCGC 5′- GCGCTGGGAAGCGTTCG TTAACCATGGAGCC ACGTGACGGACGCGGTG CCTGGGCGGCG-3′ CAGAGCCACCGCCGCTC (SEQ ID NO: 147) GCCACGAGCCTCCCGCA 5′- AGTGCTGCCTGGGGCTG GTTTGGCTTGAGCCG CGCGCGGTGACGGCCTC AGGCCGTCAC-3′ GGCTCAAGCCAAACACA (SEQ ID NO: 148) AACAGTACAAACGCCTT Second pair: AAGTCCAGCTGTAAGAG 5′- ACACCCTTTGTAC-3′ GTGACGGCCTCGGCT (SEQ ID NO: 145)/ CAAGCCAAAC-3′ EPLGGARWEAFDVTDAV (SEQ ID NO: 149) QSHRRSPRASRKCCLGLR 5′- AVTASAQAKHKQYKRLK GGATCCTTAGTACA SSCKRHPLY (SEQ ID NO: AAGGGTGTCTC-3′ 146) (SEQ ID NO: 150) 16 + 29 5′- First pair: 58.71 ±18.14 GTGGATTTCAGCGACGT 5′- TGGGTGGAATGACTGGG TTAACCATGGTGGAT CTGTGGCACCGCCGGGG TTCAGCGACG-3′ (SEQ TATCACGCCTTCTATTGC ID NO: 153) CACGGAGAATGCCCGTT 5′- CCCACTGGCTGATCATCT GCCCAGGGGCTCAA GAACTCAGATAACCATG CAGAATTAACG-3′ CCATTGTTCAGACCCTCG (SEQ ID NO: 154) TTAATTCTGTTGAGCCCC Second pair: TGGGCGGCGCGCGCTGG 5′- GAAGCGTTCGACGTGAC CGTTAATTCTGTTGA GGACGCGGTGCAGAGCC GCCCCTGGGC-3′ (SEQ ACCGCCGCTCGCAGCGA ID NO: 155) GCCTCCCGCAAGTGCTG 5′- CCTGGTTCTGCGCGCGG GGATCCTTACGAGG TGACGGCCTCG-3′ (SEQ CCGTCACCGCG-3′ ID NO: 151)/ (SEQ ID NO: 156) VDFSDVGWNDWAVAPPG YHAFYCHGECPFPLADHL NSDNHAIVQTLVNSVEPL GGARWEAFDVTDAVQSH RRSQRASRKCCLVLRAVT AS (SEQ ID NO: 152) 29 + 16 5′- First pair: 54.31 ±12.89 GAGCCCCTGGGCGGCGC 5′- GCGCTGGGAAGCGTTCG TTAACCATGGAGCC ACGTGACGGACGCGGTG CCTGGGCGGCG-3′ CAGAGCCACCGCCGCTC (SEQ ID NO: 159) GCAGCGAGCCTCCCGCA 5′- AGTGCTGCCTGGTTCTGC GCTGAAATCCACCG GCGCGGTGACGGCCTCG AGGCCGTCACC-3′ GTGGATTTCAGCGACGT (SEQ ID NO: 160) TGGGTGGAATGACTGGG Second pair: CTGTGGCACCGCCGGGG 5′- TATCACGCCTTCTATTGC GGTGACGGCCTCGGT CACGGAGAATGCCCGTT GGATTTCAGC-3′ (SEQ CCCACTGGCTGATCATCT ID NO: 161) GAACTCAGATAACCATG 5′- CCATTGTTCAGACCCTCG GGATCCTTAAACAG TTAATTCTGTT-3′ (SEQ ID AATTAACGAGG-3′ NO: 157)/ (SEQ ID NO: 162) EPLGGARWEAFDVTDAV QSHRRSQRASRKCCLVLR AVTASVDFSDVGWNDW AVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTLV NSV (SEQ ID NO: 158) 30 + 12 5′- First pair: 61.12 ±13.71 ACCGCCCTAGATGGGAC 5′- TCGGGGAGCGCAGGGAA TTAACCATGACCGCC GCGGTGGTGGCGGCGGT CTAGATGGGAC-3′ GGCGGTGGCGGCGGCGG (SEQ ID NO: 165) CGGCGGCGGCGGCGGCG 5′- GCGGCGGCGGCGCAGGC GTTTGGCTTGAGCGC AGGGGCCACGGGCGCAG CCAGCTCCTTA-3′ AGGCCGGAGCCGCTGCA (SEQ ID NO: 166) GTCGCAAGTCACTGCAC Second pair: GTGGACTTTAAGGAGCT 5′- GGGCGCTCAAGCCAAAC TAAGGAGCTGGGCG ACAAACAGTACAAACGC CTCAAGCCAAAC-3′ CTTAAGTCCAGCTGTAA (SEQ ID NO: 167) GAGACACCCTTTGTAC-3′ 5′- (SEQ ID NO: 163)/ GGATCCTTAGTACA TALDGTRGAQGSGGGGG AAGGGTGTCTCT-3′ GGGGGGGGGGGGGGGA (SEQ ID NO: 168) GRGHGRRGRSRCSRKSLH VDFKELGAQAKHKQYKR LKSSCKRHPLY (SEQ ID NO: 164) 12 + 30 5′- First pair: 59.11 ±12.47 GCTCAAGCCAAACACAA 5′- ACAGTACAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACA-3′ CACCCTTTGTACACCGCC (SEQ ID NO: 171) CTAGATGGGACTCGGGG 5′- AGCGCAGGGAAGCGGTG CATCTAGGGCGGTGT GTGGCGGCGGTGGCGGT ACAAAGGGTG-3′ GGCGGCGGCGGCGGCGG (SEQ ID NO: 172) CGGCGGCGGCGGCGGCG Second pair: GCGGCGCAGGCAGGGGC 5′- CACGGGCGCAGAGGCCG CACCCTTTGTACACC GAGCCGCTGCAGTCGCA GCCCTAGATG-3′ (SEQ AGTCACTGCACGTGGAC ID NO:173) TTTAAGGAGCTGGGC-3′ 5′- (SEQ ID NO: 169)/ GGATCCTTAGCCCA AQAKHKQYKRLKSSCKR GCTCCTTAAAG-3′ HPLYTALDGTRGAQGSG (SEQ ID NO: 174) GGGGGGGGGGGGGGGG GGGAGRGHGRRGRSRCS RKSLHVDFKELG (SEQ ID NO: 170) 16 + 30 5′- First pair: NB GTGGATTTCAGCGACGT 5′- TGGGTGGAATGACTGGG TTAACCATGGTGGAT CTGTGGCACCGCCGGGG TTCAGCGACG-3′ (SEQ TATCACGCCTTCTATTGC ID NO: 177) CACGGAGAATGCCCGTT 5′- CCCACTGGCTGATCATCT CATCTAGGGCGGTA GAACTCAGATAACCATG ACAGAATTAAC-3′ CCATTGTTCAGACCCTCG (SEQ ID NO: 178) TTAATTCTGTTACCGCCC Second pair: TAGATGGGACTCGGGGA 5′- GCGCAGGGAAGCGGTGG GTTAATTCTGTTACC TGGCGGCGGTGGCGGTG GCCCTAGATG-3′ (SEQ GCGGCGGCGGCGGCGGC ID NO: 179) GGCGGCGGCGGCGGCGG 5′- CGGCGCAGGCAGGGGCC GGATCCTTAGCCCA ACGGGCGCAGAGGCCGG GCTCCTTAAAG-3′ AGCCGCTGCAGTCGCAA (SEQ ID NO: 180) GTCACTGCACGTGGACT TTAAGGAGCTGGGC-3′ (SEQ ID NO: 175)/ VDFSDVGWNDWAVAPPG YHAFYCHGECPFPLADHL NSDNHAIVQTLVNSVTAL DGTRGAQGSGGGGGGGG GGGGGGGGGGGGAGRG HGRRGRSRCSRKSLHVDF KELG (SEQ ID NO: 176) 12 + 16 5′- First pair: 67.42 ±19.51 GCTCAAGCCAAACACAA 5′- ACAGTACAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACA-3′ CACCCTTTGTACGTGGAT (SEQ ID NO: 183) TTCAGCGACGTTGGGTG 5′- GAATGACTGGGCTGTGG CGCTGAAATCCACGT CACCGCCGGGGTATCAC ACAAAGGGTG-3′ GCCTTCTATTGCCACGG (SEQ ID NO: 184) AGAATGCCCGTTCCCAC Second pair: TGGCTGATCATCTGAAC 5′- TCAGATAACCATGCCAT CACCCTTTGTACGTG TGTTCAGACCCTCGTTAA GATTTCAGCG-3′ (SEQ TTCTGTT-3′ (SEQ ID NO: ID NO: 185) 181)/ 5′- AQAKHKQYKRLKSSCKR GGATCCTTAAACAG HPLYVDFSDVGWNDWA AATTAACGAGG-3′ VAPPGYHAFYCHGECPFP (SEQ ID NO: 186) LADHLNSDNHAIVQTLVN SV (SEQ ID NO: 182) 10 + 15 5′- First pair: 31.27 ±12.74 GCTCAAGCCAAACACAA 5′- ACAGCGGAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACA-3′ CACCCTTTGTACGTGGA (SEQ ID NO: 189) CTTCAGTGACGTGGGGT 5′- GGAATGACTGGATTGTG CACTGAAGTCCACGT GCTCCCCCGGGGTATCA ACAAAGGGTG-3′ CGCCTTTTACTGCCACGG (SEQ ID NO: 190) AGAATGCCCTTTTCCTCT Second pair: GGCTGATCATCTGAACT 5′- CCACTAATCATGCCATT CACCCTTTGTACGTG GTTCAGACGTTGGTCAA GACTTCAGTG-3′ (SEQ CTCTGTT (SEQ ID NO: ID NO: 191) 187)/ 5′- AQAKHKQRKRLKSSCKR GGATCCTTAAACAG HPLYVDFSDVGWNDWIV AGTTGACCAAC-3′ APPGYHAFYCHGECPFPL (SEQ ID NO: 192) ADHLNSTNHAIVQTLVNS V (SEQ ID NO: 188) 15 + 10 5′- First pair: 29.74 ±13.51 GTGGACTTCAGTGACGT 5′- GGGGTGGAATGACTGGA TTAACCATGGTGGA TTGTGGCTCCCCCGGGG CTTCAGTGACG-3′ TATCACGCCTTTTACTGC (SEQ ID NO: 195) CACGGAGAATGCCCTTT 5′- TCCTCTGGCTGATCATCT GTTTGGCTTGAGCAA GAACTCCACTAATCATG CAGAGTTGAC-3′ CCATTGTTCAGACGTTG (SEQ ID NO: 196) GTCAACTCTGTTGCTCAA Second pair: GCCAAACACAAACAGCG 5′- GAAACGCCTTAAGTCCA GTCAACTCTGTTGCT GCTGTAAGAGACACCCT CAAGCCAAAC-3′ TTGTAC-3′ (SEQ ID NO: (SEQ ID NO: 197) 193)/ 5′- VDFSDVGWNDWIVAPPG GGATCCTTAGTACA YHAFYCHGECPFPLADHL AAGGGTGTCTC-3′ NSTNHAIVQTLVNSVAQA (SEQ ID NO: 198) KHKQRKRLKSSCKRHPLY (SEQ ID NO: 194) 15 + 21 5′- First pair: 32.64 ±12.78 GTGGACTTCAGTGACGT 5′- GGGGTGGAATGACTGGA TTAACCATGGTGGA TTGTGGCTCCCCCGGGG CTTCAGTGACG-3′ TATCACGCCTTTTACTGC (SEQ ID NO: 201) CACGGAGAATGCCCTTT 5′- TCCTCTGGCTGATCATCT GAATCTTAGAGTTAA GAACTCCACTAATCATG CAGAGTTGAC-3′ CCATTGTTCAGACGTTG (SEQ ID NO: 202) GTCAACTCTGTTAACTCT Second pair: AAGATTCCTAAGGCATG 5′- CTGTGTCCCGACAGAAC GTCAACTCTGTTAAC TCAGTGCTATCTCGATGC TCTAAGATTC-3′ (SEQ TGTACCTTGACGAGAAT ID NO: 203) GAAAAGGTTGTATTAAA 5′- GAACTATCAGGACATGG GGATCCTTAGCGAC TTGTGGAGGGTTGTGGG ACCCACAACCC-3′ TGTCGC (SEQ ID NO: 199)/ (SEQ ID NO: 204) VDFSDVGWNDWIVAPPG YHAFYCHGECPFPLADHL NSTNHAIVQTLVNSVNSK IPKACCVPTELSAISMLYL DENEKVVLKNYQDMVVE GCGCR (SEQ ID NO: 200) 21 + 15 5′- First pair: 31.04 ±16.58 AACTCTAAGATTCCTAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAACTCT CAGAACTCAGTGCTATC AAGATTCCTA-3′ (SEQ TCGATGCTGTACCTTGAC ID NO: 207) GAGAATGAAAAGGTTGT 5′- ATTAAAGAACTATCAGG ACTGAAGTCCACGC ACATGGTTGTGGAGGGT GACACCCACAA-3′ TGTGGGTGTCGCGTGGA (SEQ ID NO: 208) CTTCAGTGACGTGGGGT Second pair: GGAATGACTGGATTGTG 5′- GCTCCCCCGGGGTATCA TTGTGGGTGTCGCGT CGCCTTTTACTGCCACGG GGACTTCAGT-3′ (SEQ AGAATGCCCTTTTCCTCT ID NO: 209) GGCTGATCATCTGAACT 5′- CCACTAATCATGCCATT GGATCCTTAAACAG GTTCAGACGTTGGTCAA AGTTGACCAAC-3′ CTCTGTT-3′ (SEQ ID NO: (SEQ ID NO: 210) 205)/ NSKIPKACCVPTELSAISM LYLDENEKVVLKNYQDM VVEGCGCRVDFSDVGWN DWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQ TLVNSV (SEQ ID NO: 206) 21 + 10 5′- First pair: 30.21 ±12.76 AACTCTAAGATTCCTAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAACTCT CAGAACTCAGTGCTATC AAGATTCCTA-3′ (SEQ TCGATGCTGTACCTTGAC ID NO: 213) GAGAATGAAAAGGTTGT 5′- ATTAAAGAACTATCAGG TTGGCTTGAGCGCGA ACATGGTTGTGGAGGGT CACCCACAAC-3′ TGTGGGTGTCGCGCTCA (SEQ ID NO: 214) AGCCAAACACAAACAGC Second pair: GGAAACGCCTTAAGTCC 5′- AGCTGTAAGAGACACCC GTTGTGGGTGTCGCG TTTGTAC-3′ (SEQ ID NO: CTCAAGCCAA-3′ 211)/ (SEQ ID NO: 215) NSKIPKACCVPTELSAISM 5′- LYLDENEKVVLKNYQDM GGATCCTTAGTACA VVEGCGCRAQAKHKQRK AAGGGTGTCTC-3′ RLKSSCKRHPLY (SEQ ID (SEQ ID NO: 216) NO: 212) 10 + 21 5′- First pair: 27.31 ±11.79 GCTCAAGCCAAACACAA 5′- ACAGCGGAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACA-3′ CACCCTTTGTACAACTCT (SEQ ID NO: 219) AAGATTCCTAAGGCATG 5′- CTGTGTCCCGACAGAAC GAATCTTAGAGTTGT TCAGTGCTATCTCGATGC ACAAAGGGTG-3′ TGTACCTTGACGAGAAT (SEQ ID NO: 220) GAAAAGGTTGTATTAAA Second pair: GAACTATCAGGACATGG 5′- TTGTGGAGGGTTGTGGG CACCCTTTGTACAAC TGTCGC (SEQ ID NO: 217)/ TCTAAGATTC-3′ (SEQ AQAKHKQRKRLKSSCKR ID NO: 221) HPLYNSKIPKACCVPTELS 5′- AISMLYLDENEKVVLKNY GGATCCTTAGCGAC QDMVVEGCGCR (SEQ ID ACCCACAACCC-3′ NO: 218) (SEQ ID NO: 222)  8 + 14 5′- First pair: 35.14 ±13.64 GGCCAAGCCAAACGCAA 5′- AGGGTATAAACGCCTTA TTAACCATGGGCCA AGTCCAGCTGTAAGAGA AGCCAAACGCA-3′ CACCCTTTGTACGTGGAT (SEQ ID NO: 225) TTCAAGGACGTTGGGTG 5′- GAATGACCATGCTGTGG CCTTGAAATCCACGT CACCGCCGGGGTATCAC ACAAAGGGTG-3′ GCCTTCTATTGCCACGG (SEQ ID NO: 226) AGAATGCCCGTTCCCAC Second pair: TGGCTGATCATCTGAAC 5′- TCAGATAACCATGCCAT CACCCTTTGTACGTG TGTTCAGACCAAGGTTA GATTTCAAGG-3′ (SEQ ATTCTGTT-3′ (SEQ ID NO: ID NO: 227) 223)/ 5′- GQAKRKGYKRLKSSCKR GGATCCTTAAACAG HPLYVDFKDVGWNDHAV AATTAACCTTG-3′ APPGYHAFYCHGECPFPL (SEQ ID NO: 228) ADHLNSDNHAIVQTKVNS V (SEQ ID NO: 224) 14 + 8 5′- First pair: 33.79 ±16.51 GTGGATTTCAAGGACGT 5′- TGGGTGGAATGACCATG TTAACCATGGTGGAT CTGTGGCACCGCCGGGG TTCAAGGACG-3′ TATCACGCCTTCTATTGC (SEQ ID NO: 231) CACGGAGAATGCCCGTT 5′- CCCACTGGCTGATCATCT GTTTGGCTTGGCCAA GAACTCAGATAACCATG CAGAATTAAC-3′ CCATTGTTCAGACCAAG (SEQ ID NO: 232) GTTAATTCTGTTGGCCAA Second pair: GCCAAACGCAAAGGGTA 5′- TAAACGCCTTAAGTCCA GTTAATTCTGTTGGC GCTGTAAGAGACACCCT CAAGCCAAAC-3′ TTGTAC-3′ (SEQ ID NO: (SEQ ID NO: 233) 229)/ 5′- VDFKDVGWNDHAVAPPG GGATCCTTAGTACA YHAFYCHGECPFPLADHL AAGGGTGTCTC-3′ NSDNHAIVQTKVNSVGQ (SEQ ID NO: 234) AKRKGYKRLKSSCKRHPL Y (SEQ ID NO: 230) 19 + 8 5′- First pair: 33.51 ±15.71 AATAGCAAAGATCCCAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAATAG CAGAACTCAGTGCCCCC CAAAGATCCCA-3′ AGCCCGCTGTACCTTGA (SEQ ID NO: 237) CGAGAATGAGAAGCCTG 5′- TACTCAAGAACTATCAG TTGGCTTGGCCGCGA GACATGGTAGTCCATGG CACCCACACC-3′ (SEQ GTGTGGGTGTCGCGGCC ID NO: 238) AAGCCAAACGCAAAGGG Second pair: TATAAACGCCTTAAGTC 5′- CAGCTGTAAGAGACACC GGTGTGGGTGTCGCG CTTTGTAC-3′ (SEQ ID NO: GCCAAGCCAA-3′ 235)/ (SEQ ID NO: 239) NSKDPKACCVPTELSAPS 5′- PLYLDENEKPVLKNYQD GGATCCTTAGTACA MVVHGCGCRGQAKRKG AAGGGTGTCTC-3′ YKRLKSSCKRHPLY (SEQ (SEQ ID NO: 240) ID NO: 236)  8 + 19 5′- First pair: 31.12 ±13.42 GGCCAAGCCAAACGCAA 5′- AGGGTATAAACGCCTTA TTAACCATGGGCCA AGTCCAGCTGTAAGAGA AGCCAAACGCA-3′ CACCCTTTGTACAATAG (SEQ ID NO: 243) CAAAGATCCCAAGGCAT 5′- GCTGTGTCCCGACAGAA GATCTTTGCTATTGT CTCAGTGCCCCCAGCCC ACAAAGGGTG-3′ GCTGTACCTTGACGAGA (SEQ ID NO: 244) ATGAGAAGCCTGTACTC Second pair: AAGAACTATCAGGACAT 5′- GGTAGTCCATGGGTGTG CACCCTTTGTACAAT GGTGTCGC-3′ (SEQ ID AGCAAAGATC-3′ NO: 241)/ (SEQ ID NO: 245) GQAKRKGYKRLKSSCKR 5′- HPLYNSKDPKACCVPTEL GGATCCTTAGCGAC SAPSPLYLDENEKPVLKN ACCCACACCCA-3′ YQDMVVHGCGCR (SEQ (SEQ ID NO: 246) ID NO: 242) 19 + 14 5′- First pair: 32.09 ±13.03 AATAGCAAAGATCCCAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAATAG CAGAACTCAGTGCCCCC CAAAGATCCCA-3′ AGCCCGCTGTACCTTGA (SEQ ID NO: 249) CGAGAATGAGAAGCCTG 5′- TACTCAAGAACTATCAG CTTGAAATCCACGCG GACATGGTAGTCCATGG ACACCCACAC-3′ GTGTGGGTGTCGCGTGG (SEQ ID NO: 250) ATTTCAAGGACGTTGGG Second pair: TGGAATGACCATGCTGT 5′- GGCACCGCCGGGGTATC GTGTGGGTGTCGCGT ACGCCTTCTATTGCCACG GGATTTCAAG-3′ (SEQ GAGAATGCCCGTTCCCA ID NO: 251) CTGGCTGATCATCTGAA 5′- CTCAGATAACCATGCCA GGATCCTTAAACAG TTGTTCAGACCAAGGTT AATTAACCTTG-3′ AATTCTGTT-3′ (SEQ ID (SEQ ID NO: 252) NO: 247)/ NSKDPKACCVPTELSAPS PLYLDENEKPVLKNYQD MVVHGCGCRVDFKDVG WNDHAVAPPGYHAFYCH GECPFPLADHLNSDNHAI VQTKVNSV (SEQ ID NO: 248) 14 + 19 5′- First pair: 30.98 ±12.07 GTGGATTTCAAGGACGT 5′- TGGGTGGAATGACCATG TTAACCATGGTGGAT CTGTGGCACCGCCGGGG TTCAAGGACG-3′ TATCACGCCTTCTATTGC (SEQ ID NO: 255) CACGGAGAATGCCCGTT 5′- CCCACTGGCTGATCATCT GATCTTTGCTATTAA GAACTCAGATAACCATG CAGAATTAAC-3′ CCATTGTTCAGACCAAG (SEQ ID NO: 256) GTTAATTCTGTTAATAGC Second pair: AAAGATCCCAAGGCATG 5′- CTGTGTCCCGACAGAAC GTTAATTCTGTTAAT TCAGTGCCCCCAGCCCG AGCAAAGATC-3′ CTGTACCTTGACGAGAA (SEQ ID NO: 257) TGAGAAGCCTGTACTCA 5′- AGAACTATCAGGACATG GGATCCTTAGCGAC GTAGTCCATGGGTGTGG ACCCACACCCA-3′ GTGTCGC-3′ (SEQ ID NO: (SEQ ID NO: 258) 253)/ VDFKDVGWNDHAVAPPG YHAFYCHGECPFPLADHL NSDNHAIVQTKVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVH GCGCR (SEQ ID NO: 254) 10 + 15 + 21 5′- First pair: 17.25 ±11.20 GCTCAAGCCAAACACAA 5′- ACAGCGGAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACA-3′ CACCCTTTGTACGTGGA (SEQ ID NO: 261) CTTCAGTGACGTGGGGT 5′- GGAATGACTGGATTGTG CACTGAAGTCCACGT GCTCCCCCGGGGTATCA ACAAAGGGTG-3′ CGCCTTTTACTGCCACGG (SEQ ID NO: 262) AGAATGCCCTTTTCCTCT Second pair: GGCTGATCATCTGAACT 5′- CCACTAATCATGCCATT CACCCTTTGTACGTG GTTCAGACGTTGGTCAA GACTTCAGTG-3′ (SEQ CTCTGTTAACTCTAAGAT ID NO: 263) TCCTAAGGCATGCTGTG 5′- TCCCGACAGAACTCAGT GAATCTTAGAGTTAA GCTATCTCGATGCTGTAC CAGAGTTGAC-3′ CTTGACGAGAATGAAAA (SEQ ID NO: 264) GGTTGTATTAAAGAACT Third pair: ATCAGGACATGGTTGTG 5′- GAGGGTTGTGGGTGTCG GTCAACTCTGTTAAC C-3′ (SEQ ID NO: 259)/ TCTAAGATTC-3′ (SEQ AQAKHKQRKRLKSSCKR ID NO: 265) HPLYVDFSDVGWNDWIV 5′- APPGYHAFYCHGECPFPL GGATCCTTAGCGAC ADHLNSTNHAIVQTLVNS ACCCACAACCC-3′ VNSKIPKACCVPTELSAIS (SEQ ID NO: 266) MLYLDENEKVVLKNYQD MVVEGCGCR (SEQ ID NO: 260) 15 + 10 + 21 5′- First pair: 15.14 ±13.21 GTGGACTTCAGTGACGT 5′- GGGGTGGAATGACTGGA TTAACCATGGTGGA TTGTGGCTCCCCCGGGG CTTCAGTGACG-3′ TATCACGCCTTTTACTGC (SEQ ID NO: 269) CACGGAGAATGCCCTTT 5′- TCCTCTGGCTGATCATCT GTTTGGCTTGAGCAA GAACTCCACTAATCATG CAGAGTTGAC-3′ CCATTGTTCAGACGTTG (SEQ ID NO: 270) GTCAACTCTGTTGCTCAA Second pair: GCCAAACACAAACAGCG 5′- GAAACGCCTTAAGTCCA GTCAACTCTGTTGCT GCTGTAAGAGACACCCT CAAGCCAAAC-3′ TTGTACAACTCTAAGATT (SEQ ID NO: 271) CCTAAGGCATGCTGTGT 5′- CCCGACAGAACTCAGTG GAATCTTAGAGTTGT CTATCTCGATGCTGTACC ACAAAGGGTG-3′ TTGACGAGAATGAAAAG (SEQ ID NO: 272) GTTGTATTAAAGAACTA Third pair: TCAGGACATGGTTGTGG 5′- AGGGTTGTGGGTGTCGC- CACCCTTTGTACAAC 3′ (SEQ ID NO: 267)/ TCTAAGATTC-3′ (SEQ VDFSDVGWNDWIVAPPG ID NO: 273) YHAFYCHGECPFPLADHL 5′- NSTNHAIVQTLVNSVAQA GGATCCTTAGCGAC KHKQRKRLKSSCKRHPLY ACCCACAACCC-3′ NSKIPKACCVPTELSAISM (SEQ ID NO: 274) LYLDENEKVVLKNYQDM VVEGCGCR (SEQ ID NO: 268) 21 + 15 + 10 5′- First pair: 14.21 ±13.51 AACTCTAAGATTCCTAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAACTCT CAGAACTCAGTGCTATC AAGATTCCTA-3′ (SEQ TCGATGCTGTACCTTGAC ID NO: 277) GAGAATGAAAAGGTTGT 5′- ATTAAAGAACTATCAGG CACTGAAGTCCACGC ACATGGTTGTGGAGGGT GACACCCACA-3′ TGTGGGTGTCGCGTGGA (SEQ ID NO: 278) CTTCAGTGACGTGGGGT Second pair: GGAATGACTGGATTGTG 5′- GCTCCCCCGGGGTATCA TGTGGGTGTCGCGTG CGCCTTTTACTGCCACGG GACTTCAGTG-3′ (SEQ AGAATGCCCTTTTCCTCT ID NO: 279) GGCTGATCATCTGAACT 5′- CCACTAATCATGCCATT GTTTGGCTTGAGCAA GTTCAGACGTTGGTCAA CAGAGTTGAC-3′ CTCTGTTGCTCAAGCCA (SEQ ID NO: 280) AACACAAACAGCGGAAA Third pair: CGCCTTAAGTCCAGCTG 5′- TAAGAGACACCCTTTGT GTCAACTCTGTTGCT AC-3′ (SEQ ID NO: 275)/ CAAGCCAAAC-3′ NSKIPKACCVPTELSAISM (SEQ ID NO: 281) LYLDENEKVVLKNYQDM 5′- VVEGCGCRVDFSDVGWN GGATCCTTAGTACA DWIVAPPGYHAFYCHGE AAGGGTGTCTC-3′ CPFPLADHLNSTNHAIVQ (SEQ ID NO: 282) TLVNSVAQAKHKQRKRL KSSCKRHPLY (SEQ ID NO: 276) 21 + 10 + 15 5′- First pair: 16.71 ±14.25 AACTCTAAGATTCCTAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAACTCT CAGAACTCAGTGCTATC AAGATTCCTA-3′ (SEQ TCGATGCTGTACCTTGAC ID NO: 285) GAGAATGAAAAGGTTGT 5′- ATTAAAGAACTATCAGG GTTTGGCTTGAGCGC ACATGGTTGTGGAGGGT GACACCCACA-3′ TGTGGGTGTCGCGCTCA (SEQ ID NO: 286) AGCCAAACACAAACAGC Second pair: GGAAACGCCTTAAGTCC 5′- AGCTGTAAGAGACACCC TGTGGGTGTCGCGCT TTTGTACGTGGACTTCAG CAAGCCAAAC-3′ TGACGTGGGGTGGAATG (SEQ ID NO: 287) ACTGGATTGTGGCTCCC 5′- CCGGGGTATCACGCCTT CACTGAAGTCCACGT TTACTGCCACGGAGAAT ACAAAGGGTG-3′ GCCCTTTTCCTCTGGCTG (SEQ ID NO: 288) ATCATCTGAACTCCACT Third pair: AATCATGCCATTGTTCA 5′- GACGTTGGTCAACTCTG CACCCTTTGTACGTG TT-3′ (SEQ ID NO: 283)/ GACTTCAGTG-3′ (SEQ NSKIPKACCVPTELSAISM ID NO: 289) LYLDENEKVVLKNYQDM 5′- VVEGCGCRAQAKHKQRK GGATCCTTAAACAG RLKSSCKRHPLYVDFSDV AGTTGACCAAC-3′ GWNDWIVAPPGYHAFYC (SEQ ID NO: 290) HGECPFPLADHLNSTNHA IVQTLVNSV (SEQ ID NO: 284)  8 + 14 + 19 5′- First pair: 15.64 ±13.24 GGCCAAGCCAAACGCAA 5′- AGGGTATAAACGCCTTA TTAACCATGGGCCA AGTCCAGCTGTAAGAGA AGCCAAACGCA-3′ CACCCTTTGTACGTGGAT (SEQ ID NO: 293) TTCAAGGACGTTGGGTG 5′- GAATGACCATGCTGTGG CCTTGAAATCCACGT CACCGCCGGGGTATCAC ACAAAGGGTG-3′ GCCTTCTATTGCCACGG (SEQ ID NO: 294) AGAATGCCCGTTCCCAC Second pair: TGGCTGATCATCTGAAC 5′- TCAGATAACCATGCCAT CACCCTTTGTACGTG TGTTCAGACCAAGGTTA GATTTCAAGG-3′ (SEQ ATTCTGTTAATAGCAAA ID NO: 295) GATCCCAAGGCATGCTG 5′- TGTCCCGACAGAACTCA GATCTTTGCTATTAA GTGCCCCCAGCCCGCTG CAGAATTAAC-3′ TACCTTGACGAGAATGA (SEQ ID NO: 296) GAAGCCTGTACTCAAGA Third pair: ACTATCAGGACATGGTA 5′- GTCCATGGGTGTGGGTG GTTAATTCTGTTAAT TCGC-3′ (SEQ ID NO: 291)/ AGCAAAGATC-3′ GQAKRKGYKRLKSSCKR (SEQ ID NO: 297) HPLYVDFKDVGWNDHAV 5′- APPGYHAFYCHGECPFPL GGATCCTTAGCGAC ADHLNSDNHAIVQTKVNS ACCCACACCCA-3′ VNSKDPKACCVPTELSAP (SEQ ID NO: 298) SPLYLDENEKPVLKNYQD MVVHGCGCR (SEQ ID NO: 292) 14 + 8 + 19 5′- First pair: 17.65 ±14.78 GTGGATTTCAAGGACGT 5′- TGGGTGGAATGACCATG TTAACCATGGTGGAT CTGTGGCACCGCCGGGG TTCAAGGACG-3′ TATCACGCCTTCTATTGC (SEQ ID NO: 301) CACGGAGAATGCCCGTT 5′- CCCACTGGCTGATCATCT GTTTGGCTTGGCCAA GAACTCAGATAACCATG CAGAATTAAC-3′ CCATTGTTCAGACCAAG (SEQ ID NO: 302) GTTAATTCTGTTGGCCAA Second pair: GCCAAACGCAAAGGGTA 5′- TAAACGCCTTAAGTCCA GTTAATTCTGTTGGC GCTGTAAGAGACACCCT CAAGCCAAAC-3′ TTGTACAATAGCAAAGA (SEQ ID NO: 303) TCCCAAGGCATGCTGTG 5′- TCCCGACAGAACTCAGT GATCTTTGCTATTGT GCCCCCAGCCCGCTGTA ACAAAGGGTG-3′ CCTTGACGAGAATGAGA (SEQ ID NO: 304) AGCCTGTACTCAAGAAC Third pair: TATCAGGACATGGTAGT 5′- CCATGGGTGTGGGTGTC CACCCTTTGTACAAT GC-3′ (SEQ ID NO: 299)/ AGCAAAGATC-3′ VDFKDVGWNDHAVAPPG (SEQ ID NO: 305) YHAFYCHGECPFPLADHL 5′- NSDNHAIVQTKVNSVGQ GGATCCTTAGCGAC AKRKGYKRLKSSCKRHPL ACCCACACCCA-3′ YNSKDPKACCVPTELSAP (SEQ ID NO: 306) SPLYLDENEKPVLKNYQD MVVHGCGCR (SEQ ID NO: 300) 19 + 8 + 14 5′- First pair: 15.97 ±12.01 AATAGCAAAGATCCCAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAATAG CAGAACTCAGTGCCCCC CAAAGATCCCA-3′ AGCCCGCTGTACCTTGA (SEQ ID NO: 309) CGAGAATGAGAAGCCTG 5′- TACTCAAGAACTATCAG GTTTGGCTTGGCCGC GACATGGTAGTCCATGG GACACCCACA-3′ GTGTGGGTGTCGCGGCC (SEQ ID NO: 310) AAGCCAAACGCAAAGGG Second pair: TATAAACGCCTTAAGTC 5′- CAGCTGTAAGAGACACC TGTGGGTGTCGCGGC CTTTGTACGTGGATTTCA CAAGCCAAAC-3′ AGGACGTTGGGTGGAAT (SEQ ID NO: 311) GACCATGCTGTGGCACC 5′- GCCGGGGTATCACGCCT CCTTGAAATCCACGT TCTATTGCCACGGAGAA ACAAAGGGTG-3′ TGCCCGTTCCCACTGGCT (SEQ ID NO: 312) GATCATCTGAACTCAGA Third pair: TAACCATGCCATTGTTCA 5′- GACCAAGGTTAATTCTG CACCCTTTGTACGTG TT-3′ (SEQ ID NO: 307)/ GATTTCAAGG-3′ (SEQ NSKDPKACCVPTELSAPS ID NO: 313) PLYLDENEKPVLKNYQD 5′- MVVHGCGCRGQAKRKG GGATCCTTAAACAG YKRLKSSCKRHPLYVDFK AATTAACCTTG-3′ DVGWNDHAVAPPGYHAF (SEQ ID NO: 314) YCHGECPFPLADHLNSDN HAIVQTKVNSV (SEQ ID NO: 308) 19 + 14 + 8 5′- First pair: 14.12 ±10.27 AATAGCAAAGATCCCAA 5′- GGCATGCTGTGTCCCGA TTAACCATGAATAG CAGAACTCAGTGCCCCC CAAAGATCCCA-3′ AGCCCGCTGTACCTTGA (SEQ ID NO: 317) CGAGAATGAGAAGCCTG 5′- TACTCAAGAACTATCAG CTTGAAATCCACGCG GACATGGTAGTCCATGG ACACCCACAC-3′ GTGTGGGTGTCGCGTGG (SEQ ID NO: 318) ATTTCAAGGACGTTGGG Second pair: TGGAATGACCATGCTGT 5′- GGCACCGCCGGGGTATC GTGTGGGTGTCGCGT ACGCCTTCTATTGCCACG GGATTTCAAG-3′ (SEQ GAGAATGCCCGTTCCCA ID NO: 319) CTGGCTGATCATCTGAA 5′- CTCAGATAACCATGCCA GTTTGGCTTGGCCAA TTGTTCAGACCAAGGTT CAGAATTAAC-3′ AATTCTGTTGGCCAAGC (SEQ ID NO: 320) CAAACGCAAAGGGTATA Third pair: AACGCCTTAAGTCCAGC 5′- TGTAAGAGACACCCTTT GTTAATTCTGTTGGC GTAC-3′ (SEQ ID NO: 315)/ CAAGCCAAAC-3′ NSKDPKACCVPTELSAPS (SEQ ID NO: 321) PLYLDENEKPVLKNYQD 5′- MVVHGCGCRVDFKDVG GGATCCTTAGTACA WNDHAVAPPGYHAFYCH AAGGGTGTCTC-3′ GECPFPLADHLNSDNHAI (SEQ ID NO: 322) VQTKVNSVGQAKRKGYK RLKSSCKRHPLY (SEQ ID NO: 316) 10 + 14 + 21 5′- First pair: 17.98 ±11.61 GCTCAAGCCAAACACAA 5′- ACAGCGGAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACAC-3′ (SEQ CACCCTTTGTACGTGGAT ID NO: 325) TTCAAGGACGTTGGGTG 5′- GAATGACCATGCTGTGG CTTGAAATCCACGTA CACCGCCGGGGTATCAC CAAAGGGTG-3′ (SEQ GCCTTCTATTGCCACGG ID NO: 326) AGAATGCCCGTTCCCAC Second pair: TGGCTGATCATCTGAAC 5′- TCAGATAACCATGCCAT CACCCTTTGTACGTG TGTTCAGACCAAGGTTA GATTTCAAG-3′ (SEQ ATTCTGTTAACTCTAAGA ID NO: 327) TTCCTAAGGCATGCTGT 5′- GTCCCGACAGAACTCAG GAATCTTAGAGTTAA TGCTATCTCGATGCTGTA CAGAATTAAG-3′ CCTTGACGAGAATGAAA (SEQ ID NO: 328) AGGTTGTATTAAAGAAC Third pair: TATCAGGACATGGTTGT 5′- GGAGGGTTGTGGGTGTC GTTAATTCTGTTAAC GC-3′ (SEQ ID NO: 323)/ TCTAAGATTC-3′ (SEQ AQAKHKQRKRLKSSCKR ID NO: 329) HPLYVDFKDVGWNDHAV 5′- APPGYHAFYCHGECPFPL GGATCCTTAGCGAC ADHLNSDNHAIVQTKVNS ACCCACAACCC-3′ VNSKIPKACCVPTELSAIS (SEQ ID NO: 330) MLYLDENEKVVLKNYQD MVVEGCGCR (SEQ ID NO: 324)  8 + 15 + 19 5′- First pair: 16.49 ±12.04 GGCCAAGCCAAACGCAA 5′- AGGGTATAAACGCCTTA TTAACCATGGGCCA AGTCCAGCTGTAAGAGA AGCCAAACGC-3′ CACCCTTTGTACGTGGA (SEQ ID NO: 333) CTTCAGTGACGTGGGGT 5′- GGAATGACTGGATTGTG ACTGAAGTCCACGTA GCTCCCCCGGGGTATCA CAAAGGGTC-3′ (SEQ CGCCTTTTACTGCCACGG ID NO: 334) AGAATGCCCTTTTCCTCT Second pair: GGCTGATCATCTGAACT 5′- CCACTAATCATGCCATT CACCCTTTGTACGTG GTTCAGACGTTGGTCAA GACTTCAGT-3′ (SEQ CTCTGTTAATAGCAAAG ID NO: 335) ATCCCAAGGCATGCTGT 5′- GTCCCGACAGAACTCAG GATCTTTGCTATTAA TGCCCCCAGCCCGCTGT CAGAGTTGAC-3′ ACCTTGACGAGAATGAG (SEQ ID NO: 336) AAGCCTGTACTCAAGAA Third pair: CTATCAGGACATGGTAG 5′- TCCATGGGTGTGGGTGT GTCAACTCTGTTAAT CGC-3′ (SEQ ID NO: 331)/ AGCAAAGATC-3′ GQAKRKGYKRLKSSCKR (SEQ ID NO: 337) HPLYVDFSDVGWNDWIV 5′- APPGYHAFYCHGECPFPL GGATCCTTAGCGAC ADHLNSTNHAIVQTLVNS ACCCACACCCA-3′ VNSKDPKACCVPTELSAP (SEQ ID NO: 338) SPLYLDENEKPVLKNYQD MVVHGCGCR (SEQ ID NO: 332) 10 + 19 + 14 5′- First pair: 16.98 ±13.97 GCTCAAGCCAAACACAA 5′- ACAGCGGAAACGCCTTA TTAACCATGGCTCAA AGTCCAGCTGTAAGAGA GCCAAACACA-3′ CACCCTTTGTACAATAG (SEQ ID NO: 341) CAAAGATCCCAAGGCAT 5′- GCTGTGTCCCGACAGAA GATCTTTGCTATTGT CTCAGTGCCCCCAGCCC ACAAAGGGTG-3′ GCTGTACCTTGACGAGA (SEQ ID NO: 342) ATGAGAAGCCTGTACTC Second pair: AAGAACTATCAGGACAT 5′- GGTAGTCCATGGGTGTG CACCCTTTGTACAAT GGTGTCGCGTGGATTTC AGCAAAGATC-3′ AAGGACGTTGGGTGGAA (SEQ ID NO: 343) TGACCATGCTGTGGCAC 5′- CGCCGGGGTATCACGCC CTTGAAATCCACGCG TTCTATTGCCACGGAGA ACACCCACAC-3′ ATGCCCGTTCCCACTGG (SEQ ID NO: 344) CTGATCATCTGAACTCA Third pair: GATAACCATGCCATTGT 5′- TCAGACCAAGGTTAATT GTGTGGGTGTCGCGT CTGTT-3′ (SEQ ID NO: 339)/ GGATTTCAAG-3′ (SEQ AQAKHKQRKRLKSSCKR ID NO: 345) HPLYNSKDPKACCVPTEL 5′- SAPSPLYLDENEKPVLKN GGATCCTTAAACAG YQDMVVHGCGCRVDFK AATTAACCTTG-3′ DVGWNDHAVAPPGYHAF (SEQ ID NO: 346) YCHGECPFPLADHLNSDN HAIVQTKVNSV (SEQ ID NO: 340)  8 + 21 + 15 5′- First pair: 17.11 ±12.10 GGCCAAGCCAAACGCAA 5′- AGGGTATAAACGCCTTA TTAACCATGGGCCA AGTCCAGCTGTAAGAGA AGCCAAACGC-3′ CACCCTTTGTACAACTCT (SEQ ID NO: 349) AAGATTCCTAAGGCATG 5′- CTGTGTCCCGACAGAAC GAATCTTAGAGTTGT TCAGTGCTATCTCGATGC ACAAAGGGTG-3′ TGTACCTTGACGAGAAT (SEQ ID NO: 350) GAAAAGGTTGTATTAAA Second pair: GAACTATCAGGACATGG 5′- TTGTGGAGGGTTGTGGG CACCCTTTGTACAAC TGTCGCGTGGACTTCAG TCTAAGATTC-3′ (SEQ TGACGTGGGGTGGAATG ID NO: 351) ACTGGATTGTGGCTCCC 5′- CCGGGGTATCACGCCTT TCACTGAAGTCCACG TTACTGCCACGGAGAAT CGACACCCAC-3′ GCCCTTTTCCTCTGGCTG (SEQ ID NO: 352) ATCATCTGAACTCCACT Third pair: AATCATGCCATTGTTCA 5′- GACGTTGGTCAACTCTG GTGGGTGTCGCGTGG TT-3′ (SEQ ID NO: 347)/ ACTTCAGTGA-3′ (SEQ GQAKRKGYKRLKSSCKR ID NO: 353) HPLYNSKIPKACCVPTELS 5′- AISMLYLDENEKVVLKNY GGATCCTTAAACAG QDMVVEGCGCRVDFSDV AGTTGACCAAC-3′ GWNDWIVAPPGYHAFYC (SEQ ID NO: 354) HGECPFPLADHLNSTNHA IVQTLVNSV (SEQ ID NO: 348) NB: Binding is below detection limit (KD > 1 mM)

The data shows that the affinity constant (K_(D)) was lower for recombinant polypeptides formed from the following combinations of two clones as compared to the individual polypeptides from each single clone: clone no. 10 operably linked with clone no. 15 (SEQ ID NO: 188), clone no. 15 operably linked with clone no. 10 (SEQ ID NO: 194), clone no. 15 operably linked with clone no. 21 (SEQ ID NO: 200), clone no. 21 operably linked with clone no. 15 (SEQ ID NO: 206), clone no. 21 operably linked with clone no. 10 (SEQ ID NO: 212), clone no. 10 operably linked with clone no. 21 (SEQ ID NO: 218), clone no. 8 operably linked with clone no. 14 (SEQ ID NO: 224), clone no. 14 operably linked with clone no. 8 (SEQ ID NO: 230), clone no. 19 operably linked with clone no. 8 (SEQ ID NO: 236), clone no. 8 operably linked with clone no. 19 (SEQ ID NO: 242), clone no. 19 operably linked with clone no. 14 (SEQ ID NO: 248), and clone no. 14 operably linked with clone no. 19 (SEQ ID NO: 254). In other words, the recombinant polypeptides resulting from the noted combinations had a higher affinity against ActRIIBecd than the individual polypeptides from each of clone no. 8 (SEQ ID NO: 35), clone no. 10 (SEQ ID NO: 39), clone no. 14 (SEQ ID NO: 47), clone no. 15 (SEQ ID NO: 49), clone no. 19 (SEQ ID NO: 57), and clone no. 21 (SEQ ID NO: 61).

In addition, recombinant polypeptides were produced from combinations of three clones using clone no. 8 (SEQ ID NO: 35), clone no. 10 (SEQ ID NO: 39), clone no. 14 (SEQ ID NO: 47), clone no. 15 (SEQ ID NO: 49), clone no. 19 (SEQ ID NO: 57), and clone no. 21 (SEQ ID NO: 61). Surprisingly, the K_(D) of recombinant polypeptides formed from the following combinations of three clones was lower than for polypeptides from the individual clones or from combinations of two clones: clone no. 10 operably linked with clone nos. 15 and 21 (SEQ ID NO: 260), clone no. 15 operably linked with clone nos. 10 and 21 (SEQ ID NO: 268), clone no. 21 operably linked with clone nos. 15 and 10 (SEQ ID NO: 276), clone no. 21 operably linked with clone nos. 10 and 15 (SEQ ID NO: 284), clone no. 8 operably linked with clone nos. 14 and 19 (SEQ ID NO: 292), clone no. 14 operably linked with clone nos. 8 and 19 (SEQ ID NO: 300), clone no. 19 operably linked with clone nos. 8 and 14 (SEQ ID NO: 308), clone no. 19 operably linked with clone nos. 14 and 8 (SEQ ID NO: 316), clone no. 10 operably linked with clone nos. 14 and 21 (SEQ ID NO: 324), clone no. 8 operably linked with clone nos. 15 and 19 (SEQ ID NO: 332), clone no. 10 operably linked with clone nos. 19 and 14 (SEQ ID NO: 340), and clone no. 8 operably linked with clone nos. 21 and 15 (SEQ ID NO: 348).

Example 7: Post-Translation Modification

The effect of post-translation modification (PTM) on K_(D) values of the recombinant polypeptides was investigated. One example of PTM is disulfide bond connection. Data showing the relation between disulfide bond location and binding affinity is provided in TABLE 4, which shows that PTM affects the binding affinity of the recombinant polypeptides against ActRIIBecd. The PTM assay was performed according to the following experiments.

A. Enzymatic Digestion and Dimethyl Labeling

Polypeptides were prepared as in Examples 4 and 6. Standard proteins were purchased from Sigma (St. Louise, Mo.). Optionally, 5 mM NEM (N-ethylmaleimide) (Sigma) in 100 mM sodium acetate (J. T. Baker, Phillipsburg, N.J.), pH 6, was used to block free cysteines at room temperature for 30 min. Enzymatic digestion was performed directly in sodium acetate at 37° C. overnight with 1:50 trypsin (Promega, Madison, Wis.). Protein digest was diluted three times with 100 mM sodium acetate (pH 5) before dimethyl labeling.

In certain embodiments, recombinant polypeptides prepared as in Examples 4 and 6 were diluted with 50 mM TEABC (Triethylammonium bicarbonate, T7408, Sigma-Aldrich) buffer (pH7) and split into two tubes for different enzymatic digestion. First, NEM (N-ethylmaleimide, E3876, Sigma-Aldrich) was added at a final concentration of 5 mM to block free cysteines. The alkylation reaction was performed for 30 min at room temperature. After NEM alkylation, one tube was added with trypsin (V5111, Promega) (1:65) at 37° C. for 18 hrs followed by Glu-C (P8100S, New England BioLabs) (1:50) digestion at 37° C. overnight. Another one was added with Glu-C(1:50) at 37° C. for 18 hrs followed by chymotrypsin (1:50) digestion at 37° C. overnight.

To perform dimethyl labeling, 2.5 μL of 4% (w/v) formaldehyde-H₂ (J. T. Baker) or 2.5 μL of 4% (w/v) formaldehyde-D₂ (Aldrich) was added to 504 of protein digest followed by the addition of 2.5 μL of 600 mM sodium cyanoborohydride (Sigma), and the reaction was performed at pH 5-6 for 30 min.

B. Mass Spectrometry

ESI Q-TOF equipped with a CapLC system (Waters, Milford, Mass.) utilizing a capillary column (75 μm i.d., 10 cm in length, Csun, Taiwan) was used to perform the survey scan (MS, m/z 400-1600; MS/MS, m/z 50-2000). The alkylated and dimethyl-labeled protein digest was subject to LC-MS/MS analysis with a linear gradient from 5% to 50% acetonitrile containing 0.1% formic acid over 45 min.

In certain embodiments, the digested and dimethyl labeled protein digest were analyzed with Q-Exactive Plus mass spectrometer coupled with Ultimate 3000 RSLC system. The LC separation was performed using the C18 column (Acclaim PepMap RSLC, 75 μm×150 mm, 2 μm, 100 Å) with the gradient shown below:

Time Flow (min) A % B % (μL/min) 0 99 1 0.25 6 99 1 0.25 45 70 30 0.25 48 40 60 0.25 50 20 80 0.25 60 20 80 0.25 65 99 1 0.25 70 99 1 0.25

Mobile phase A: 0.1% formic acid

Mobile phase B: 95% acetonitrile/0.1% formic acid

Full MS scan was performed with the range of m/z 300-2000, and the ten most intense ions from MS scan were subjected to fragmentation for MS/MS spectra.

C. Data Analysis.

MassLynx 4.0 was used to produce peak lists from raw data (subtract 30%, smooth 3/2 Savitzky Golay and center three channels 80% centroid). A relatively high subtraction can be applied to eliminate background noise. True a₁ ions usually appear as major peaks so that they can be kept in the peak list.

D. Reversed-Phase Chromatography.

An Agilent 1100 HPLC system with a binary pump was equipped with a UV detector and an autosampler. The proteins were injected onto a Zorbax 300SB C8 column (150_2.1 mm, 5_m, 300 A) operated at 75° C. The flow rate was 0.5 ml/min. Mobile-phase A was water containing 0.1% trifluoroacetic acid. Mobile-phase B was 70% isopropyl alcohol, 20% acetonitrile, and aqueous 0.1% trifluoroacetic acid. Samples were injected at a loading condition of 10% B and increased to 19% B over 2 min. Alinear elution gradient of 1.1% B/min started at 2 min and ended at 24 min. The column was then flushed for 5 min with 95% B. The column was reequilibrated with the loading condition for 5 min. This method was able to partially resolve disulfide isoforms.

TABLE 4 Recombinant Polypeptide Identified Cysteine Affinity Constant SEQ ID NO Sequence Pairs Mean[nm] SD[nm] 188 AQAKHKQRKRLKSSCKRH C15-C44^(a) 42.32 ±2.12 PLYVDFSDVGWNDWIVAP PGYHAFYCHGECPFPLADH LNSTNHAIVQTLVNSV 188 AQAKHKQRKRLKSSCKRH C44-C48^(a) 21.47 ±1.72 PLYVDFSDVGWNDWIVAP PGYHAFYCHGECPFPLADH LNSTNHAIVQTLVNSV 194 VDFSDVGWNDWIVAPPGY C23-C65^(a) 45.98 ±2.01 HAFYCHGECPFPLADHLNS TNHAIVQTLVNSVAQAKH KQRKRLKSSCKRHPLY 194 VDFSDVGWNDWIVAPPGY C23-C27^(a) 18.14 ±1.67 HAFYCHGECPFPLADHLNS TNHAIVQTLVNSVAQAKH KQRKRLKSSCKRHPLY 200 VDFSDVGWNDWIVAPPGY C23-C27^(a), C58-C91^(a), 18.62 ±1.41 HAFYCHGECPFPLADHLNS C59-C93^(a) TNHAIVQTLVNSVNSKIPK ACCVPTELSAISMLYLDEN EKVVLKNYQDMVVEGCG CR 200 VDFSDVGWNDWIVAPPGY C23-C27^(a), C58-C93^(a), 20.13 ±2.06 HAFYCHGECPFPLADHLNS C59-C91^(a) TNHAIVQTLVNSVNSKIPK ACCVPTELSAISMLYLDEN EKVVLKNYQDMVVEGCG CR 200 VDFSDVGWNDWIVAPPGY C23-C27^(a), C58-C91^(b), 19.75 ±1.98 HAFYCHGECPFPLADHLNS C59-C93^(b) TNHAIVQTLVNSVNSKIPK ACCVPTELSAISMLYLDEN EKVVLKNYQDMVVEGCG CR 200 VDFSDVGWNDWIVAPPGY C23-C58^(a) 47.62 ±2.89 HAFYCHGECPFPLADHLNS TNHAIVQTLVNSVNSKIPK ACCVPTELSAISMLYLDEN EKVVLKNYQDMVVEGCG CR 206 NSKIPKACCVPTELSAISML C67-C71^(a), C8-C41^(a), 15.49 ±3.12 YLDENEKVVLKNYQDMV C9-C43^(a) VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SV 206 NSKIPKACCVPTELSAISML C8-C71^(a) 49.66 ±1.09 YLDENEKVVLKNYQDMV VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SV 206 NSKIPKACCVPTELSAISML C67-C71^(a), C8-C43^(a), 17.73 ±1.70 YLDENEKVVLKNYQDMV C9-C41^(a) VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SV 206 NSKIPKACCVPTELSAISML C67-C71^(a), C8-C43^(b), 16.97 ±2.15 YLDENEKVVLKNYQDMV C9-C41^(b) VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SV 212 NSKIPKACCVPTELSAISML C59-C59^(b), C8-C41^(a), 18.13 ±2.21 YLDENEKVVLKNYQDMV C9-C43^(a) VEGCGCRAQAKHKQRKRL KSSCKRHPLY 212 NSKIPKACCVPTELSAISML C59-C59^(b), C8-C43^(a), 19.34 ±1.56 YLDENEKVVLKNYQDMV C9-C41^(a) VEGCGCRAQAKHKQRKRL KSSCKRHPLY 212 NSKIPKACCVPTELSAISML C41-C59^(a) 44.33 ±3.09 YLDENEKVVLKNYQDMV VEGCGCRAQAKHKQRKRL KSSCKRHPLY 218 AQAKHKQRKRLKSSCKRH C15-C15^(b), C29-C62^(a), 16.22 ±1.62 PLYNSKIPKACCVPTELSAI C30-C64^(a) SMLYLDENEKVVLKNYQD MVVEGCGCR 218 AQAKHKQRKRLKSSCKRH C15-C15^(b), C29-C64^(a), 18.42 ±1.79 PLYNSKIPKACCVPTELSAI C30-C62^(a) SMLYLDENEKVVLKNYQD MVVEGCGCR 218 AQAKHKQRKRLKSSCKRH C15-C30^(a) 40.89 ±2.62 PLYNSKIPKACCVPTELSAI SMLYLDENEKVVLKNYQD MVVEGCGCR 224 GQAKRKGYKRLKSSCKRH C44-C48^(a) 22.31 ±1.99 PLYVDFKDVGWNDHAVAP PGYHAFYCHGECPFPLADH LNSDNHAIVQTKVNSV 224 GQAKRKGYKRLKSSCKRH C15-C44^(a) 48.93 ±2.88 PLYVDFKDVGWNDHAVAP PGYHAFYCHGECPFPLADH LNSDNHAIVQTKVNSV 230 VDFKDVGWNDHAVAPPG C23-C27^(a) 17.94 ±2.31 YHAFYCHGECPFPLADHLN SDNHAIVQTKVNSVGQAK RKGYKRLKSSCKRHPLY 230 VDFKDVGWNDHAVAPPG C27-C65^(a) 52.23 ±1.63 YHAFYCHGECPFPLADHLN SDNHAIVQTKVNSVGQAK RKGYKRLKSSCKRHPLY 236 NSKDPKACCVPTELSAPSP C59-C59^(b), C8-C41^(a), 16.21 ±2.10 LYLDENEKPVLKNYQDMV C9-C43^(a) VHGCGCRGQAKRKGYKRL KSSCKRHPLY 236 NSKDPKACCVPTELSAPSP C41-C59^(a) 49.51 ±3.30 LYLDENEKPVLKNYQDMV VHGCGCRGQAKRKGYKRL KSSCKRHPLY 236 NSKDPKACCVPTELSAPSP C59-C59^(b), C8-C43^(a), 17.05 ±1.27 LYLDENEKPVLKNYQDMV C9-C41^(a) VHGCGCRGQAKRKGYKRL KSSCKRHPLY 242 GQAKRKGYKRLKSSCKRH C15-C15^(b), C29-C62^(a), 17.78 ?’. 09 PLYNSKDPKACCVPTELSA C30-C64^(a) PSPLYLDENEKPVLKNYQD MVVHGCGCR 242 GQAKRKGYKRLKSSCKRH C29-C30^(a) 48.66 ±3.15 PLYNSKDPKACCVPTELSA PSPLYLDENEKPVLKNYQD MVVHGCGCR 242 GQAKRKGYKRLKSSCKRH C15-C15^(b), C29-C64^(a), 18.11 ±1.63 PLYNSKDPKACCVPTELSA C30-C62^(a) PSPLYLDENEKPVLKNYQD MVVHGCGCR 248 NSKDPKACCVPTELSAPSP C67-C71^(a), C8-C41^(a), 18.52 ±1.74 LYLDENEKPVLKNYQDMV C9-C43a VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SV 248 NSKDPKACCVPTELSAPSP C41-C43^(a) 47.81 ±3.22 LYLDENEKPVLKNYQDMV VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SV 248 NSKDPKACCVPTELSAPSP C67-C71^(a), C8-C43^(a), 19.98 ±2.14 LYLDENEKPVLKNYQDMV C9-C41^(a) VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SV 248 NSKDPKACCVPTELSAPSP C67-C71^(a), C8-C43^(b), 19.25 ?'. 01 LYLDENEKPVLKNYQDMV C9-C41^(b) VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SV 254 VDFKDVGWNDHAVAPPG C23-C27^(a), C58-C91^(a), 17.55 ±1.74 YHAFYCHGECPFPLADHLN C59-C93^(a) SDNHAIVQTKVNSVNSKDP KACCVPTELSAPSPLYLDE NEKPVLKNYQDMVVHGC GCR 254 VDFKDVGWNDHAVAPPG C23-C27^(a), C58-C93^(a), 19.06 ±2.39 YHAFYCHGECPFPLADHLN C59-C91^(a) SDNHAIVQTKVNSVNSKDP KACCVPTELSAPSPLYLDE NEKPVLKNYQDMVVHGC GCR 254 VDFKDVGWNDHAVAPPG C23-C58^(a) 44.43 ±2.05 YHAFYCHGECPFPLADHLN SDNHAIVQTKVNSVNSKDP KACCVPTELSAPSPLYLDE NEKPVLKNYQDMVVHGC GCR 254 VDFKDVGWNDHAVAPPG C23-C27^(a), C58-C91^(b), 18.73 ±1.65 YHAFYCHGECPFPLADHLN C59-C93^(b) SDNHAIVQTKVNSVNSKDP KACCVPTELSAPSPLYLDE NEKPVLKNYQDMVVHGC GCR 260 AQAKHKQRKRLKSSCKRH C15-C80, C44- 6.56 ±1.12 PLYVDFSDVGWNDWIVAP C112^(a), C48-C114^(a), PGYHAFYCHGECPFPLADH C79-C79^(b) LNSTNHAIVQTLVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 260 AQAKHKQRKRLKSSCKRH C79-C80^(a) 29.14 ±1.35 PLYVDFSDVGWNDWIVAP PGYHAFYCHGECPFPLADH LNSTNHAIVQTLVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 260 AQAKHKQRKRLKSSCKRH C15-C15^(b), C79- 7.64 ±1.03 PLYVDFSDVGWNDWIVAP C114^(a), C80-C112^(a), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSTNHAIVQTLVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 260 AQAKHKQRKRLKSSCKRH C80-C114^(a), C79- 8.31 ±1.07 PLYVDFSDVGWNDWIVAP C112^(a), C44-C48^(a) PGYHAFYCHGECPFPLADH LNSTNHAIVQTLVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 260 AQAKHKQRKRLKSSCKRH C15-C15^(b), C80- 7.45 ±1.67 PLYVDFSDVGWNDWIVAP C114^(a), C79-C112^(a), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSTNHAIVQTLVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 260 AQAKHKQRKRLKSSCKRH C80-C114^(b), C79- 6.89 ±0.96 PLYVDFSDVGWNDWIVAP C112^(b), C44-C48^(a) PGYHAFYCHGECPFPLADH LNSTNHAIVQTLVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 268 VDFSDVGWNDWIVAPPGY C23-C27^(a), C65-C65^(b), 7.21 ±1.32 HAFYCHGECPFPLADHLNS C79-C112^(a), C80- TNHAIVQTLVNSVAQAKH C114^(a) KQRKRLKSSCKRHPLYNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 268 VDFSDVGWNDWIVAPPGY C23-C79^(a) 29.57 ±2.71 HAFYCHGECPFPLADHLNS TNHAIVQTLVNSVAQAKH KQRKRLKSSCKRHPLYNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 268 VDFSDVGWNDWIVAPPGY C23-C27^(a), C65-C65^(b), 8.74 ±2.08 HAFYCHGECPFPLADHLNS C79-C114^(a), C80- TNHAIVQTLVNSVAQAKH C112^(a) KQRKRLKSSCKRHPLYNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 268 VDFSDVGWNDWIVAPPGY C23-C27^(a), C65-C65^(b), 7.96 ±0.75 HAFYCHGECPFPLADHLNS C79-C112^(b), C80- TNHAIVQTLVNSVAQAKH C114^(b) KQRKRLKSSCKRHPLYNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 268 VDFSDVGWNDWIVAPPGY C23-C27^(a), C65-C65^(b), 8.03 ±2.45 HAFYCHGECPFPLADHLNS C79-C114^(b), C80- TNHAIVQTLVNSVAQAKH C112^(b) KQRKRLKSSCKRHPLYNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 276 NSKIPKACCVPTELSAISML C67-C71^(a), C8-C41^(a), 5.71 ±1.60 YLDENEKVVLKNYQDMV C9-C43^(a), C109-C109^(b) VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SVAQAKHKQRKRLKSSCK RHPLY 276 NSKIPKACCVPTELSAISML C8-C9^(a) 27.93 ±2.35 YLDENEKVVLKNYQDMV VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SVAQAKHKQRKRLKSSCK RHPLY 276 NSKIPKACCVPTELSAISML C67-C71^(a), C8-C43^(a), 7.66 ±1.05 YLDENEKVVLKNYQDMV C9-C41^(a), C109-C109^(b) VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SVAQAKHKQRKRLKSSCK RHPLY 276 NSKIPKACCVPTELSAISML C67-C71^(a), C8-C43^(b), 6.31 ±1.38 YLDENEKVVLKNYQDMV C9-C41^(b), C109-C109^(b) VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SVAQAKHKQRKRLKSSCK RHPLY 276 NSKIPKACCVPTELSAISML C67-C71^(a), C8-C41^(b), 8.13 ±1.77 YLDENEKVVLKNYQDMV C9-C43^(b), C109-C109^(b) VEGCGCRVDFSDVGWND WIVAPPGYHAFYCHGECPF PLADHLNSTNHAIVQTLVN SVAQAKHKQRKRLKSSCK RHPLY 284 NSKIPKACCVPTELSAISML C59-C59^(b), C8-C41^(a), 4.89 ±1.13 YLDENEKVVLKNYQDMV C9-C43^(a), C88-C92^(a) VEGCGCRAQAKHKQRKRL KSSCKRHPLYVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 284 NSKIPKACCVPTELSAISML C8-C9^(a) 31.79 ±3.15 YLDENEKVVLKNYQDMV VEGCGCRAQAKHKQRKRL KSSCKRHPLYVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 284 NSKIPKACCVPTELSAISML C59-C59^(b), C8-C43^(a), 6.88 ±1.35 YLDENEKVVLKNYQDMV C9-C41^(a), C88-C92^(a) VEGCGCRAQAKHKQRKRL KSSCKRHPLYVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 284 NSKIPKACCVPTELSAISML C59-C59^(b), C8-C41^(b), 5.79 ±1.76 YLDENEKVVLKNYQDMV C9-C43^(b), C88-C92^(a) VEGCGCRAQAKHKQRKRL KSSCKRHPLYVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 284 NSKIPKACCVPTELSAISML C59-C59^(b), C8-C43^(b), 6.91 ±1.55 YLDENEKVVLKNYQDMV C9-C41^(b), C88-C92^(a) VEGCGCRAQAKHKQRKRL KSSCKRHPLYVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 292 GQAKRKGYKRLKSSCKRH C15-C80^(a), C44- 4.77 ±0.67 PLYVDFKDVGWNDHAVAP C112^(a), C48-C114^(a), PGYHAFYCHGECPFPLADH C79-C79^(b) LNSDNHAIVQTKVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 292 GQAKRKGYKRLKSSCKRH C79-C80^(a) 28.99 ±2.66 PLYVDFKDVGWNDHAVAP PGYHAFYCHGECPFPLADH LNSDNHAIVQTKVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 292 GQAKRKGYKRLKSSCKRH C15-C15^(b), C79- 5.81 ±3.57 PLYVDFKDVGWNDHAVAP C114^(a), C80-C112^(a), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSDNHAIVQTKVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 292 GQAKRKGYKRLKSSCKRH C80-C114^(a), C79- 6.19 ±1.37 PLYVDFKDVGWNDHAVAP C112^(a), C44-C48^(a) PGYHAFYCHGECPFPLADH LNSDNHAIVQTKVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 292 GQAKRKGYKRLKSSCKRH C80-C114^(b), C79- 5.54 ±1.30 PLYVDFKDVGWNDHAVAP C112^(b), C44-C48^(a) PGYHAFYCHGECPFPLADH LNSDNHAIVQTKVNSVNSK DPKACCVPTELSAPPLYL DENEKPVLKNYQDMVVHG CGCR 300 VDFKDVGWNDHAVAPPG C23-C27^(a), C65-C65^(b), 5.14 ±1.39 YHAFYCHGECPFPLADHLN C79-C112^(a), C80- SDNHAIVQTKVNSVGQAK C114^(a) RKGYKRLKSSCKRHPLYNS KDPKACCVPTELSAPSPLY LDENEKPVLKNYQDMVVH GCGCR 300 VDFKDVGWNDHAVAPPG C23-C79^(a) 32.69 ±2.45 YHAFYCHGECPFPLADHLN SDNHAIVQTKVNSVGQAK RKGYKRLKSSCKRHPLYNS KDPKACCVPTELSAPSPLY LDENEKPVLKNYQDMVVH GCGCR 300 VDFKDVGWNDHAVAPPG C23-C27^(a), C65-C65^(b), 7.37 ±1.71 YHAFYCHGECPFPLADHLN C79-C114^(a), C80- SDNHAIVQTKVNSVGQAK C112^(a) RKGYKRLKSSCKRHPLYNS KDPKACCVPTELSAPSPLY LDENEKPVLKNYQDMVVH GCGCR 300 VDFKDVGWNDHAVAPPG C23-C27^(a), C65-C65^(b), 6.44 ±1.72 YHAFYCHGECPFPLADHLN C79-C112^(b), C80- SDNHAIVQTKVNSVGQAK C114^(b) RKGYKRLKSSCKRHPLYNS KDPKACCVPTELSAPSPLY LDENEKPVLKNYQDMVVH GCGCR 308 NSKDPKACCVPTELSAPSP C59-C59^(b), C8-C41^(a), 5.98 ±1.43 LYLDENEKPVLKNYQDMV C9-C43^(a), C88-C92^(a) VHGCGCRGQAKRKGYKRL KSSCKRHPLYVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 308 NSKDPKACCVPTELSAPSP C8-C9^(a) 31.22 ±2.07 LYLDENEKPVLKNYQDMV VHGCGCRGQAKRKGYKRL KSSCKRHPLYVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 308 NSKDPKACCVPTELSAPSP C59-C59^(b), C8-C43^(a), 6.11 ±1.33 LYLDENEKPVLKNYQDMV C9-C41^(a), C88-C92^(a) VHGCGCRGQAKRKGYKRL KSSCKRHPLYVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 308 NSKDPKACCVPTELSAPSP C59-C59^(b), C8-C41^(b), 6.73 ±1.55 LYLDENEKPVLKNYQDMV C9-C43^(b), C88-C92^(a) VHGCGCRGQAKRKGYKRL KSSCKRHPLYVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 316 NSKDPKACCVPTELSAPSP C67-C71^(a), C8-C41^(a), 5.34 ±1.37 LYLDENEKPVLKNYQDMV C9-C43^(a), C109-C109^(b) VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SVGQAKRKGYKRLKSSCK RHPLY 316 NSKDPKACCVPTELSAPSP C8-C67^(a) 28.91 ±2.65 LYLDENEKPVLKNYQDMV VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SVGQAKRKGYKRLKSSCK RHPLY 316 NSKDPKACCVPTELSAPSP C67-C71^(a), C8-C43^(a), 6.17 ±1.04 LYLDENEKPVLKNYQDMV C9-C41^(a), C109-C109^(b) VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SVGQAKRKGYKRLKSSCK RHPLY 316 NSKDPKACCVPTELSAPSP C67-C71^(a), C8-C43^(b), 5.78 ±1.18 LYLDENEKPVLKNYQDMV C9-C41^(b), C109-C109^(b) VHGCGCRVDFKDVGWND HAVAPPGYHAFYCHGECPF PLADHLNSDNHAIVQTKVN SVGQAKRKGYKRLKSSCK RHPLY 324 AQAKHKQRKRLKSSCKRH C15-C15^(b), C79- 8.42 ±1.59 PLYVDFKDVGWNDHAVAP C114^(a), C80-C112^(a), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSDNHAIVQTKVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 324 AQAKHKQRKRLKSSCKRH C79-C80^(a) 29.33 ±2.10 PLYVDFKDVGWNDHAVAP PGYHAFYCHGECPFPLADH LNSDNHAIVQTKVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 324 AQAKHKQRKRLKSSCKRH C80-C114^(a), C79- 7.22 ±2.15 PLYVDFKDVGWNDHAVAP C112^(a), C44-C48^(a) PGYHAFYCHGECPFPLADH LNSDNHAIVQTKVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 324 AQAKHKQRKRLKSSCKRH C15-C15^(b), C80- 9.11 ±1.77 PLYVDFKDVGWNDHAVAP C114^(b), C79-C112^(b), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSDNHAIVQTKVNSVNSK IPKACCVPTELSAISMLYLD ENEKVVLKNYQDMVVEGC GCR 340 AQAKHKQRKRLKSSCKRH C15-C15^(b), C29-C62^(a), 5.77 ±1.17 PLYNSKDPKACCVPTELSA C30-C64^(a), C88-C92^(a) PSPLYLDENEKPVLKNYQD MVVHGCGCRVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 340 AQAKHKQRKRLKSSCKRH C15-C29^(a) 30.05 ±2.63 PLYNSKDPKACCVPTELSA PSPLYLDENEKPVLKNYQD MVVHGCGCRVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 340 AQAKHKQRKRLKSSCKRH C15-C15^(b), C29-C64^(a), 7.19 ±1.95 PLYNSKDPKACCVPTELSA C30-C62^(a), C88-C92^(a) PSPLYLDENEKPVLKNYQD MVVHGCGCRVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 340 AQAKHKQRKRLKSSCKRH C15-C15^(b), C29-C64^(b), 6.37 ±1.55 PLYNSKDPKACCVPTELSA C30-C62^(b), C88-C92^(a) PSPLYLDENEKPVLKNYQD MVVHGCGCRVDFKDVGW NDHAVAPPGYHAFYCHGE CPFPLADHLNSDNHAIVQT KVNSV 332 GQAKRKGYKRLKSSCKRH C15-C15^(b), C80- 5.98 ±1.11 PLYVDFSDVGWNDWIVAP C114^(a), C79-C112^(a), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSTNHAIVQTLVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 332 GQAKRKGYKRLKSSCKRH C79-C80^(a) 28.54 ±2.36 PLYVDFSDVGWNDWIVAP PGYHAFYCHGECPFPLADH LNSTNHAIVQTLVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 332 GQAKRKGYKRLKSSCKRH C15-C15^(b), C80- 7.18 ±1.84 PLYVDFSDVGWNDWIVAP C112^(a), C79-C114^(a), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSTNHAIVQTLVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 332 GQAKRKGYKRLKSSCKRH C15-C15^(b), C80- 7.42 ±1.94 PLYVDFSDVGWNDWIVAP C114^(b), C79-C112^(b), PGYHAFYCHGECPFPLADH C44-C48^(a) LNSTNHAIVQTLVNSVNSK DPKACCVPTELSAPSPLYL DENEKPVLKNYQDMVVHG CGCR 348 GQAKRKGYKRLKSSCKRH C15-C15^(b), C29-C62^(a), 5.10 ±1.07 PLYNSKIPKACCVPTELSAI C30-C64^(a), C88-C92^(a) SMLYLDENEKVVLKNYQD MVVEGCGCRVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 348 GQAKRKGYKRLKSSCKRH C29-C30^(a) 29.09 ±3.33 PLYNSKIPKACCVPTELSAI SMLYLDENEKVVLKNYQD MVVEGCGCRVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 348 GQAKRKGYKRLKSSCKRH C15-C15^(b), C29-C64^(a), 6.77 ±1.92 PLYNSKIPKACCVPTELSAI C30-C62^(a), C88-C92^(a) SMLYLDENEKVVLKNYQD MVVEGCGCRVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV 348 GQAKRKGYKRLKSSCKRH C15-C15^(b), C29-C62^(b), 6.31 ±1.45 PLYNSKIPKACCVPTELSAI C30-C64^(b), C88-C92^(a) SMLYLDENEKVVLKNYQD MVVEGCGCRVDFSDVGW NDWIVAPPGYHAFYCHGE CPFPLADHLNSTNHAIVQT LVNSV ^(a)Intramolecular disulfide bond connection. bIntermolecular disulfide bond connection for dimerization.

As shown in TABLE 4, the disulfide bond between different cysteine locations affects affinity constant (K_(D)) values. In addition, the data show that a disulfide bond between two recombinant polypeptides in a dimer significantly reduces the K_(D) values. In other words, dimerization might assist in vitro molecular bonding between the dimers of recombinant polypeptides and the ActRIIBecd.

Some recombinant polypeptides were observed to spontaneously form dimeric proteins as shown in Table 4. All of the dimeric proteins could be fractionated out of the recombinant polypeptide by gel filtration described in Example 4B. In this embodiment, the dimeric proteins were homodimeric protein because their monomer were the same. In the other embodiments, the dimeric proteins could be heterodimeric protein if the stably transformed E. coli cells as described in Example 4 are co-expressed by two different recombinant polypeptides selected from the group of SEQ ID Nos: 260, 268, 276, 284, 292, 300, 308, 316, 324, 332, 340, and 348.

Example 8: Alkaline Phosphatase Bioactivity Assay

The ability of the recombinant polypeptides to bind to cellular receptors and induce signal transduction pathways was investigated using an assay for alkaline phosphatase induction in C2C12 cells, which has been described. See, e.g., Peel et al. J Craniofacial Surg. 2003; 14:284-291 and Hu et al. Growth Factors 2004; 22:29033.

C2C12 cells (ATCC accession number CRL-1772, Manassas, Va.) were passaged before confluent and resuspended at 1×10⁵ cells/mL in DMEM supplemented with 10% heat-inactivated fetal bovine serum. 100 μL of cell suspension was seeded per well of a 96 well tissue culture plate (Corning, Cat #3595). Aliquots of serial diluted standard and test sample were added and the cultures maintained at 37° C. and 5% CO₂. Test samples included conditioned media, purified recombinant polypeptide, and as a positive control a commercially available purified recombinant human BMP-2 “rhBMP-2” (R&D Systems, Minneapolis, USA). rhBMP-2 has been shown to play an important role in the development of bone and cartilage by, for example, Mundy GR., et al. (2004, Growth Factors. 22 (4): 233-41). Negative control cultures (cultured in media without added sample or rhBMP-2) were cultured for 2 to 7 days. Medium was changed every two days.

At harvest cultures were rinsed with normal saline (0.90% NaCl, pH 7.4) and discard the rinsed saline. 50 μL extraction solution (Takara Bio, catalogue #MK301) was added to those cultures and then sonicated at room temperature for 10 minutes. The lysate was assayed for alkaline phosphatase (ALP) by monitoring the hydrolysis of nitrophenol phosphate in alkaline buffer (Sigma-Aldrich, St. Louis Mo., catalog P5899) as described in Peel et al. J Craniofacial Surg. 2003; 14:284-291 or by using the TRACP & ALP assay kit (Takara Bio, catalogue #MK301) according to manufacturer's instructions. ALP activity was determined by recording absorbance at 405 nm. An activity score was calculated by mean ALP activity of duplicate samples. Serial diluted samples and its relevant activity score were diagramed by 4-parameter curve fit so as to calculate the concentration EC₅₀ of each recombinant polypeptide. Data is shown in TABLE 5. In some embodiments, the ALP activity the cellular protein content in each well is normalized by using the Coomasie (Bradford) Protein Assay (Pierce Biotechnology Inc., catalogue #23200). The normalized ALP activity for each sample is calculated by dividing the ALP activity per well by the protein content per well.

In another embodiment, alkaline phosphatase assay described by Katagiri, T., et al. (1990, Biochem. Biophys. Res. Commun. 172, 295-299) is performed. Mouse fibroblast cells from the line C3H10T1/2 in BME-Earle medium plus 10% fetal calf serum are incubated at 1×10⁵ cells/mL in 1-mL aliquots in a 24-well plate for 24 h at 37° C. and 10% CO₂. After removal of the supernatant, 1 mL fresh medium is added with various concentrations of sample. After a further cultivation for 4 days, cells are lysed in 0.2 mL buffer (0.1 M glycerol, pH 9.6, 1% NP-40, 1 mM MgCl₂, 1 mM ZnCl₂) and alkaline phosphatase activity is determined in 50 μL aliquots of the cleared lysate using 150 μL 0.3 mM p-nitrophenyl phosphate in the pH 9.6 buffer as substrate. Absorbance at 405 nm is recorded after 20 min incubation at 37° C. The activity is related to the protein content (BCA protein assay, Pierce Chemical Co.) in each sample.

TABLE 5 Identified EC₅₀ Mean K_(D) SEQ ID NO Cysteine Pairs [nM] [nM] 188 C15-C44^(a) NA 42.32 188 C44-C48^(a) 28.4 21.47 194 C23-C65^(a) NA 45.98 194 C23-C27^(a) NA 18.14 200 C23-C27^(a), C58-C91^(a), C59- 31.2 18.62 C93^(a) 200 C23-C27^(a), C58-C93^(a), C59- NA 20.13 C91^(a) 200 C23-C27^(a), C58-C91^(b), C59- 35.1 19.75 C93^(b) 200 C23-C58^(a) NA 47.62 206 C67-C71^(a), C8-C41^(a), C9-C43^(a) 37.6 15.49 206 C8-C71^(a) NA 49.66 206 C67-C71^(a), C8-C43^(a), C9-C41^(a) NA 17.73 206 C67-C71^(a), C8-C43^(b), C9-C41^(b) 40.1 16.97 212 C59-C59^(b), C8-C41^(a), C9-C43^(a) 35.1 18.13 212 C59-C59^(b), C8-C43^(a), C9-C41^(a) 36.7 19.34 212 C41-C59^(a) NA 44.33 218 C15-C15^(b), C29-C62^(a), C30- 33.9 16.22 C64^(a) 218 C15-C15^(b), C29-C64^(a), C30- 37.6 18.42 C62^(a) 218 C15-C30^(a) NA 40.89 224 C44-C48^(a) NA 21.47 224 C15-C44^(a) NA 48.93 230 C23-C27^(a) NA 17.94 230 C27-C65^(a) NA 52.23 236 C59-C59^(b), C8-C41^(a), C9-C43^(a) 28.5 16.21 236 C41-C59^(a) NA 49.51 236 C59-C59^(b), C8-C43^(a), C9-C41^(a) 29.7 17.05 242 C15-C15^(b), C29-C62^(a), C30- 30.1 17.78 C64^(a) 242 C29-C30^(a) NA 48.66 242 C15-C15^(b), C29-C64^(a), C30- 33.9 18.11 C62^(a) 248 C67-C71^(a), C8-C41^(a), C9-C43^(a) 29.4 18.52 248 C41-C43^(a) NA 47.81 248 C67-C71^(a), C8-C43^(a), C9-C41^(a) NA 19.98 248 C67-C71^(a), C8-C43^(b), C9-C41^(b) 30.5 19.25 254 C23-C27^(a), C58-C91^(a), C59- 31.4 17.55 C93^(a) 254 C23-C27^(a), C58-C93^(a), C59- NA 19.06 C91^(a) 254 C23-C58^(a) NA 44.43 254 C23-C27^(a), C58-C91^(b), C59- 34.4 18.73 C93^(b) 260 C15-C80^(a), C44-C112^(a), C48- 14.1 6.56 C114^(a), C79-C79^(b) 260 C79-C80^(a) 67.8 29.14 260 C15-C15^(b), C79-C114^(a), C80-  1.1 7.64 C112^(a), C44-C48^(a) 260 C80-C114^(a), C79-C112^(a), C44- 19.4 8.31 C48^(a) 260 C15-C15^(b), C80-C114^(a), C79-  1.3 7.45 C112^(a), C44-C48^(a) 260 C79-C114^(a), C80-C112^(a), C44- 15.6 6.17 C48^(a) 260 C44-C48^(a)  9.8 8.04 260 C15-C15^(b), C80-C114^(b), C79-  1.0 4.04 C112^(b), C44-C48^(a) 260 C15-C15^(b), C79-C114^(b), C80-  1.9 4.03 C112^(b), C44-C48^(a) 260 C80-C114^(b), C79-C112^(b), C44- 13.4 6.89 C48^(a) 260 C79-C114^(b), C80-C112^(b), C44- 10.5 6.05 C48^(a) 268 C23-C27^(a), C65-C65^(b), C79- 18.4 7.21 C112^(a), C80-C114^(a) 268 C23-C79^(a) 71.1 29.57 268 C23-C27^(a), C65-C65^(b), C79- 20.4 8.74 C114^(a), C80-C112^(a) 268 C23-C27^(a), C65-C65^(b), C79- 18.6 7.96 C112^(b), C80-C114^(b) 268 C23-C27^(a), C65-C65^(b), C79- 24.5 8.03 C114^(b), C80-C112^(b) 268 C23-C27^(a) 23.4 8.41 276 C67-C71^(a), C8-C41^(a), C9- 21.9 5.71 C43^(a), C109-C109^(b) 276 C8-C9^(a) 130.1  27.93 276 C67-C71^(a), C8-C43^(a), C9- 25.7 7.66 C41^(a), C109-C109^(b) 276 C67-C71^(a), C8-C43^(b), C9- 31.7 6.31 C41^(b), C109-C109^(b) 276 C67-C71^(a), C8-C41^(b), C9- 26.3 8.13 C43^(b), C109-C109^(b) 276 C67-C71^(a) 22.5 7.41 284 C59-C59^(b), C8-C41^(a), C9- 27.1 4.89 C43^(a), C88-C92^(a) 284 C8-C9^(a) 83.9 31.79 284 C59-C59^(b), C8-C43^(a), C9- 36.7 6.88 C41^(a), C88-C92^(a) 284 C59-C59^(b), C8-C41^(b), C9- 33.9 5.79 C43^(b), C88-C92^(a) 284 C59-C59^(b), C8-C43^(b), C9- 19.5 6.91 C41^(b), C88-C92^(a) 284 C88-C92^(a) 25.9 8.14 292 C15-C80^(a), C44-C112^(a), C48- 10.7 4.77 C114^(a), C79-C79^(b) 292 C79-C80^(a) 89.4 28.99 292 C15-C15^(b), C79-C114^(a), C80- 22.5 5.81 C112^(a), C44-C48^(a) 292 C80-C114^(a), C79-C112^(a), C44- 19.8 6.19 C48^(a) 292 C80-C114^(b), C79-C112^(b), C44- 22.3 5.54 C48^(a) 292 C44-C48^(a) 27.5 7.81 300 C23-C27^(a), C65-C65^(b), C79- 17.6 5.14 C112^(a), C80-C114^(a) 300 C23-C79^(a) 86.1 32.69 300 C23-C27^(a), C65-C65^(b), C79- 12.1 7.37 C114^(a), C80-C112^(a) 300 C23-C27^(a), C65-C65^(b), C79- 27.7 6.44 C112^(b), C80-C114^(b) 300 C23-C27^(a) 16.5 8.92 308 C59-C59^(b), C8-C41^(a), C9- 33.9 5.98 C43^(a), C88-C92^(a) 308 C8-C9^(a) 77.4 31.22 308 C59-C59^(b), C8-C43^(a), C9- 20.4 6.11 C41^(a), C88-C92^(a) 308 C59-C59^(b), C8-C41^(b), C9- 36.7 6.73 C43^(b), C88-C92^(a) 308 C88-C92^(a) 38.2 7.8 308 C8-C43^(a), C9-C41^(a), C88-C92^(a) 21.7 10.9 316 C67-C71^(a), C8-C41^(a), C9- 21.0 5.34 C43^(a), C109-C109^(b) 316 C8-C67^(a) 109.1  28.91 316 C67-C71^(a), C8-C43^(a), C9- 41.5 6.17 C41^(a), C109-C109^(b) 316 C67-C71^(a), C8-C43^(b), C9- 18.5 5.78 C41^(b), C109-C109^(b) 316 C67-C71^(a) 33.9 4.67 324 C15-C15^(b), C79-C114^(a), C80- 17.7 8.42 C112^(a), C44-C48^(a) 324 C79-C80^(a) 88.7 29.33 324 C80-C114^(a), C79-C112^(a), C44- 27.1 7.22 C48^(a) 324 C15-C15^(b), C80-C114^(b), C79- 37.6 9.11 C112^(b), C44-C48^(a) 324 C44-C48^(a) 29.5 8.75 340 C15-C15^(b), C29-C62^(a), C30- 18.9 5.77 C64^(a), C88-C92^(a) 340 C15-C29^(a) 78.4 30.05 340 C15-C15^(b), C29-C64^(a), C30- 21.2 7.19 C62^(a), C88-C92^(a) 340 C15-C15^(b), C29-C64^(b), C30- 26.7 6.37 C62^(b), C88-C92^(a) 340 C88-C92^(a) 36.7 5.64 332 C15-C15^(b), C80-C114^(a), C79- 22.4 5.98 C112^(a), C44-C48^(a) 332 C79-C80^(a) 102.3  28.54 332 C15-C15^(b), C80-C112^(a), C79- 14.9 7.18 C114^(a), C44-C48^(a) 332 C15-C15^(b), C80-C114^(b), C79- 33.6 7.42 C112^(b), C44-C48^(a) 348 C15-C15^(b), C29-C62^(a), C30- 20.5 5.10 C64^(a), C88-C92^(a) 348 C29-C30^(a) 90.3 29.09 348 C15-C15^(b), C29-C64^(a), C30- 18.9 6.77 C62^(a), C88-C92^(a) 348 C15-C15^(b), C29-C62^(b), C30- 35.6 6.31 C64^(b), C88-C92^(a) 348 C88-C92^(a) 27.6 4.51 rhBMP-2 NA 45.2 NA NA: not yet analyzed ^(a)Intramolecular disulfide bond connection. ^(b)Intermolecular disulfide bond connection for dimerization.

As shown by TABLE 5, most of the recombinant polypeptides with certain disulfide connections have a value of EC₅₀ lower than that of rhBMP-2. In other words, most of the recombinant polypeptides with certain disulfide connections were able to induce a signal transduction pathway related to bone or cartilage formation or osteogenesis.

Example 9: In Vivo Osteoinductive Activity

Osteoinductive activity of a homodimeric protein including two recombinant polypeptides produced according to Example 6 (i.e., SEQ ID NO: 260, including intramolecular disulfide bond C44-C48) and porous beta-tricalcium phosphate (β-TCP) as a carrier material was evaluated in ulnar shaft defects in rabbits. The calcium phosphate carrier has a calcium to phosphate ratio of about 0.4 to about 1.65.

20 mm-sized circumferential defects were created in the shaft of surgically exposed right and left ulnae in each of 40 female rabbits (strain NZW, Japan SLC, Inc.). Briefly, combined anesthesia was carried out with ketamine hydrochloride (Ketalar, Daiichi Sankyo Co., Ltd.) and xylazine (Selactar 2% injection solution, Bayer Medical Co., Ltd.) at a combined rate of 3:1. The same solution was used for additional anesthesia in long operations. Before operating, Flumarin (flomoxef sodium, Shionogi & Co., Ltd.) was administered subcutaneously as an antibiotic agent. Fur in the general region of the forearm was shaved with an electric shaver and disinfected with Hibitane alcohol (0.5% chlorhexidine gluconate-ethanol solution, Sumitomo Dainippon Pharma, Co., Ltd.). A longitudinal incision was made on each caudomedial part of limb over the ulna. Muscle tissue was lifted to expose the ulna. A mark was made with a scalpel 25 mm from the hand joint of the exposed ulna. Proper holes were drilled longitudinally and vertically at the mark using a 15 mm diameter drill, paying close attention not to break the bone. The bone was split with a luer bone rongeurs. A mark was also made at 20 mm away in the proximal direction, and split similarly. When split, the ulna was covered with periosteum, which was then removed, and the bone fragments were thoroughly cleaned with saline.

Each ulna then received an implant or no implant according to one of Groups A-G, shown in Table 6, below. Groups A-D ulnae received a single implant of β-TCP carrying a specified amount of homodimeric protein. Group E ulnae received a single implant of β-TCP alone, without any homodimeric protein. Group F ulnae received a single implant of a bone autograft. Group G ulnae received no implant. Afterwards, muscle and dermal tissues were promptly sutured.

TABLE 6 Homodimeric protein β-TCP Homodimeric protein dose per β-TCP Group (mg) (μg) (mg/g) A 200 2 0.01 B 200 6 0.03 C 200 20 0.1 D 200 60 0.3 E 200 0 0 F Autograft (iliac bone fragments): 0.55 g on average (no β-TCP or homodimeric protein) G Defect only (no β-TCP or homodimeric protein)

β-TCP as used in Groups A-E was in the form of 1-3 mm granules with a porosity of 75% and a pore diameter of 50-350 μm (Superpore™, pentax, “HOYA” Bone Graft Substitute, Japan).

In certain embodiments, β-TCP as used in Groups A-E is in the form of 1-3 mm granules with a porosity of 70% or more and a pore diameter of 300-600 μm (“Wiltrom” Osteocera Bone Graft Substitute, Wiltrom Co., Ltd., Taiwan, R.O.C.).

Homodimeric protein including recombinant polypeptides (i.e., SEQ ID NO: 260) in Groups A-D was prepared from frozen lots immediately before implantation for each animal using 0.5 mM hydrochloric acid (standard solution diluted with injection solvent (Otsuka Pharmaceutical Co., Ltd.)). Fluid volume was set at 180 μl for unilateral implantation and was dropped evenly across 200 mg of β-TCP granules in a sterilized Petri dish. When the fluid was completely dropped, the β-TCP granules were gently stirred with a spatula, allowed to sit for more than 15 minutes at room temperature, and then implanted.

For Group F, autograft bone was obtained from either the right or left wing of the ilium using luer bone rongeurs. Bones were processed into chips, and the same amount of bone was implanted as the amounts in Groups A-E.

X-Ray Evaluation

Lateral and frontal X-ray images (i.e., radiographs) were taken immediately after implantation and once every two weeks thereafter until 8 weeks after implantation. The condition of the implanted sites and the degree of bone formation were evaluated using the radiographs. Representative examples of X-ray images for each group are shown in FIG. 1A (Groups A-D) and FIG. 1B (Groups E-G).

At 2 weeks, contrast of granules of grafting material and the boundary with the recipient bed were clearly seen in all groups. At 4 weeks, TCP granules became unclear in the homodimeric protein groups (i.e., Groups A-D), showing absorption of the granules and progress of bone formation. The boundaries between the implanted site and the recipient bed were unclear in some samples in Group C and in Group D with high dose of the homodimeric protein. At 6 weeks, the boundary between the implanted site and the recipient bed became unclear in Group B. Improved continuity in the recipient bed and formation of the bone cortex were observed in some samples in Group C and in Group D. At 8 weeks, the boundary at the recipient bed became even more unclear in Groups A and B. Continuity in the recipient bed and formation of bone cortex improved in Group C. Reconstruction of the region of the ulnar defect was observed in Group D, as shown in the image at 6 weeks.

In Group E with TCP alone, bone formation in the recipient bed was observed over time. However, remaining TCP granules were clearly seen even at 8 weeks, showing insufficient bone formation at the implantation site and poor continuity in the recipient bed. Thus, repair of defects in Group E was still incomplete at 8 weeks.

In Group F with autograft, progress of bone formation was observed over time, and fusion with the recipient bed was achieved at 8 weeks. However, formation was not uniform.

In Group G with only the defect and no implant, slight bone formation in the radius was observed at 8 weeks without any other repair of the defect.

Computerized Tomography (CT) Scanning

Axial orientation was performed at 1 mm intervals using CT scanning (GE Yokogawa Medical Systems Ltd.) immediately, at 4 weeks, and at 8 weeks after implantation. Images were mainly taken at the implant sites. Change in cross-sectional images over time at the center of the implanted sites are shown for representative examples in FIG. 2A (Groups A-D) and FIG. 2B (Groups E-G).

In Groups A to D with homodimeric protein, the granules observed immediately after implantation were partially degraded in the cross-sectional image at 4 weeks, suggesting bone formation. In Group D having a dose of 60 μg, further progress in bone formation was observed, and the formation of bone-marrow cavities in some samples was observed. At 8 weeks, progress in the formation of bone-marrow cavities and bone cortex was observed in the images for groups with doses over 6 μg. In Group E with only TCP, an agglomerated mass of granules remained even at 8 weeks. In Group F with autograft, formation of bone-marrow cavities was observed at 8 weeks, as in the remodeling process. In Group G with only defect, only slight bone formation was observed.

Torsional Strength Test

The grafting materials were removed from rabbits that were euthanized 8 weeks after implantation, and a torsional strength test was conducted for each group on the ulnae samples from which the radii were separated. 858 Mini Bionix II (MTS Systems Corporation) was used for the test. The test was conducted on a 50 mm-long area, namely, the 20 mm-long reconstructed area in the ulnar shaft at the center, and the 15 mm-long areas on both the proximal and distal sides of the reconstructed area. The edges of each side were fixed with dental resin. The resin parts were chucked in a measurement equipment. The left ulna was turned counterclockwise and the right ulna clockwise at a rotation rate of 30°/min, in order to determine maximum torque at failure. The separately obtained ulnae of healthy rabbits were also examined and compared. These healthy ulnae were obtained from Japanese white rabbits, a different type than those used in Groups A-E. The Japanese white rabbits were, however, the same age and gender as for Groups A-E at the time of euthanization, namely 26 weeks old and female.

The maximum torque of each group obtained by the torsional strength test is shown in FIG. 3. In Groups A-D with homodimeric protein, maximum torque was dose-dependently high.

Significantly high values were seen in Groups A-D with a dose of 2 μg and over of homodimeric protein as compared to Group E with TCP alone.

Significantly high values were also seen in Groups B-D with a dose of 6 μg and over of homodimeric protein as compared to Group G with defect only.

No significant difference was observed among groups with an intact ulna, autograft, or homodimeric protein.

Due to insufficient bone formation in Groups E and G, it was difficult to ensure the support in some samples when the radii were separated. Therefore, only 2 samples from Group E and 4 sample from Group G were used in the test, while 6 samples were used from each of Groups A-D and F.

Table 7 below shows a comparison of test conditions and results between this study and the evaluation of CHO-derived BMP-2 in Kokubo et al., Biomaterials 24:1643-1651 (2003), using the same animal model. Compared to the report by Kokubo et al., this study was conducted under more difficult conditions, such as a larger bone defect, a smaller dose of active agent, and a shorter duration of implantation prior to torsional strength testing. However, ulnae were shown to be successfully repaired in this study, and maximum torque in this study was remarkably similar.

TABLE 7 Size of Length of Source defect Weeks after torsion of test Chemical agent Maximum of data Carrier (mm) implantation specimen (mm) dose torque Kokubo PGS* 15 16 45 100 μg BMP-2 0.307 et al. 400 μg BMP-2 0.365 1000 μg BMP-2 0.413 This Study TCP 20 8 50 2 μg h.p.{circumflex over ( )} 0.262 granule 6 μg h.p. 0.375 20 μg h.p. 0.392 60 μg h.p. 0.400 *PGS: PLGA-coated Gelatin Sponge {circumflex over ( )}h.p.: homodimeric protein

Histological Evaluation

Specimens were prepared for all animals in 8 week and 4 week groups. Tissue obtained at the time of necropsy were preserved in 4% paraformaldehyde solution and decalcified with 10% EDTA. The tissue was then paraffin-embedded. Thinly-sliced samples were prepared on the plane running parallel to the long axis of the radius, hematoxylin and eosin (HE) stained, and histologically evaluated. Conditions of bone formation and fusion to the recipient bed were determined.

In Groups A to D with homodimeric protein, bone formation progressed to a trabecular pattern at 4 weeks. Active bone formation was observed in samples with a high dose of homodimeric protein. A significantly large amount of new bone and angiogenesis were observed in Group D with a dose of 60 μg. Remaining material was observed in some samples in Groups A and B with a low dose, while almost none was observed in Groups C and D. In Groups A and B, cartilage formation was observed in some samples near the boundary with the recipient bed. In all samples, the recipient bed was directly connected to the newly formed bone in a trabecular pattern. At 8 weeks, a trabecular pattern and remaining materials were still observed in Group A with a dose of 2 μg. Cartilage was also observed near the boundary with the recipient bed. Even though remodeling was insufficient, progress in bone formation was observed. The formation of bone cortex in the radii was observed in some samples. In Groups B to D with doses over 6 μg, bone cortex and bone marrow were being formed by remodeling. The progress was more significant in higher dose groups. Continuity in the recipient site also increased.

In Group E with TCP alone, bone formation on the grafting materials was observed in the radii, but remaining materials were still clearly seen even at 8 weeks, showing insufficient bone formation on the shaft and poor continuity.

In Group F with autograft, good bone formation on the grafted bone fragments was seen at 4 weeks, and new bone was in contact with the recipient bed. Cartilage formation was seen near the boundary with the recipient bed. At 8 weeks, progress in remodeling of new bone and formation of bone cortex were observed, but remaining grafted bone fragments were still observed.

In Group G with only defect, bone formation was observed only in the radii, and repair of the defect was not achieved.

In the embodiment, a method of promoting healing of a long-bone fracture in a subject in need of such treatment was provided. The method includes preparing a composition including the homodimeric protein homogeneously entrained within a slow release biodegradable calcium phosphate carrier (e.g., β-TCP) that hardens so as to impermeable to efflux of the homodimeric protein in vivo sufficiently that the long-bone fracture healing is confined to the volume of the calcium phosphate carrier and implanting the composition at a location where the long-bone fracture occurs, wherein the homodimeric protein is in an amount of from about 0.03 mg/g to about 3.2 mg/g of the calcium phosphate carrier.

Example 10: In Vivo Ovine Posterolateral Fusion Study

Osteoinductive activity of a homodimeric protein including a recombinant polypeptide (Rcp) produced according to Example 6 (i.e., SEQ ID NO: 260, including intramolecular disulfide bonds C44-C48, C80-C112 and C79-C114) and porous beta-tricalcium phosphate (β-TCP) as a carrier material was evaluated in ovine posterolateral fusion model. The calcium phosphate carrier has a calcium to phosphate ratio of about 1.2 to about 1.8.

The ovine posterolateral fusion model used sheep sedated with Zoletil (8-12 mg/kg, IM), and gassed down with isofluorane (2%) and oxygen (2 litres per minute). An endotracheal tube was inserted and the animal ventilated, anesthesia was maintained using isofluorane (2 to 3%) and oxygen (2-4 litres per minute). Antibiotics (Keflin®: 1 gm IV; Benacillin 5 ml IM) were given. Carprofen (an NSAID, 4 ml IM) and Temgesic® (Burprenorphine 0.324 mg SC) were injected prior to surgery. Crystalloid fluids (Hartmann's solution) were given intravenously at 4 to 10 ml/kg/h prior to and during the surgery as required.

A 15-cm midline incision was made parallel to the lumbar transverse process at the L3-L4 level. Blunt retroperitoneal dissection exposed the anterolateral aspect of the lumbar spine. This left the diaphragm undisturbed. The soft tissues were retracted. A pneumatic burr (Midas Rex) was used to decorticate the transverse processes (15 mm lateral) and adjacent vertebral body between the levels in all animals.

The graft materials were placed between the decorticated surfaces of the transverse processes and the vertebral bodies (paraspinal bed) according to one of Groups 1-6, shown in Table 8, below. Groups 1-3 received a single implant of β-TCP carrying a specified amount of homodimeric protein. Group 4 received a single implant of β-TCP alone, without any homodimeric protein. Group 6 received a single implant of absorbable collagen sponge (ACS) with a specified amount of rhBMP-2, a well-established osteoinductive factor as positive control. Group 5 received a single implant of bone autograft. Autografts were harvested from the iliac crests in the autograft group animals. The bones were morcelized using a rongeur and 5.0 g of autograft bone used for each side of the fusion. The incisions were closed with 2-0 absorbable suture and the skin approximated using 3-0 suture.

TABLE 8 Homodimeric protein Group/No. (mg/site) Carrier Fixation Time point Sample Size 1 h.p.{circumflex over ( )} High 10.5 3.5 g β-TCP None 12 wks 6 2 h.p.{circumflex over ( )} Middle 3.5 3.5 g β-TCP None 12 wks 6 3 h.p.{circumflex over ( )} Low 1.05 3.5 g β-TCP None 12 wks 6 4 None N/A 3.5 g β-TCP None 12 wks 6 5 None N/A Autograft None 12 wks 6 6 Infuse ® + 3.15 rh- ACS 4 cm³ None 12 wks 6 Mastergraft ® BMP-2 Mastergraft ® mg/site 5 cm³ {circumflex over ( )}h.p.: homodimeric protein

β-TCP as used in Groups 1-4 was in the form of 2-4 mm granules with a porosity of 70% and a pore diameter of 50-350 μm (Superpore™, pentax, “HOYA” Bone Graft Substitute, Japan).

In certain embodiments, β-TCP as used in Groups 1-4 is in the form of 2-8 mm granules with a porosity of 65% or more and a pore diameter of 250-730 μm (“Wiltrom” Osteocera Bone Graft Substitute, Wiltrom Co., Ltd., Taiwan, R.O.C.).

In Group 1, homodimeric protein including Rcp (i.e., SEQ ID NO: 260) stock solution H was prepared by adding 2 ml injection water to each of vials with 10 mg homodimeric protein. The stock solution H was mixed with injection water by 3:1 on volume ratio to form Homodimeric Protein High Dose Solution (containing 10.5 mg homodimeric protein in 2.8 ml solution). 2.8 ml Homodimeric Protein High Dose Solution was delivered by dropping evenly into 3.5 g β-TCP granule.

In Group 2, homodimeric protein stock solution ML (2.5 mg/ml) was prepared by adding 4 ml injection water to each of vial with 10 mg homodimeric protein. The stock solution ML was mixed with injection water by 1:1 on volume ratio to form homodimeric protein Middle Dose Solution (containing 3.5 mg homodimeric protein in 2.8 ml solution). 2.8 ml Homodimeric Protein Middle Dose Solution was delivered by dropping evenly into 3.5 g β-TCP granule.

In Group 3, homodimeric protein stock solution ML (2.5 mg/ml) was prepared by adding 4 ml injection water to each of vial with 10 mg homodimeric protein. The stock solution ML was mixed with injection water by 17:3 on volume ratio to form homodimeric protein Low Dose Solution (containing 1.05 mg homodimeric protein in 2.8 ml solution). 2.8 ml homodimeric protein Low Dose Solution was delivered by dropping evenly into 3.5 g β-TCP granule.

Group 6 was conducted to compare commercial product Infuse® and Mastergraft® as graft materials, both are distributed by Medtronic. Infuse® consisted of rh-BMP-2 prepared by CHO expression system and absorbable collagen sponge (“ACS”). Mastergraft® is granular calcium phosphate bone substitute consisting of 85% β-TCP and 15% Hydroxyapatite. Application of Infuse® combined with Mastergraft® on posterolateral lumber fusion showed efficacy and was reported by E. Dawson et. al., on the clinical study with evidence level 2 (J Bone Joint Surg Am. 2009; 91: 1604-13). Graft material for Group 6 consisted of 3.15 mg rh-BMP-2, 4 cc ACS and 5 cc Mastergraft® per site, and procedure of graft material preparation were followed as E. Dawson's report. Lot number of Infuse® and Mastergraft® were recorded on operation record.

The animals were monitored daily for the first 7 days following surgery and observations recorded on post-operative monitoring sheets for each animal.

Posteroanterior radiographs of all animals were taken at 4 weeks. The animals were sedated with Zoletil® (8-12 mg/kg, IM), and gassed down with Isofluorane (2%) and oxygen (2 litres per minute). The radiographs were used to compare to the post-operative X-rays for the presence of new bone and absorption of the TCP material. At 12 weeks post surgery all animals were sacrificed via lethal cardiac injection of Lethobarb.

To monitor the time of bone formation, three different fluorochromes were intravenously injected at three time points as indicated in the Table 9 below.

TABLE 9 The date and dosage of fluorochrome used* Alizarin complexone Calcien Engemycin ® Supplier Sigma Sigma Schering Plough Solvent 1.4% NaHCO₃ 1.4% NaHCO₃ Physiological saline pH 6-8 6-8 6-8 Dosage (mg/kg 28 mg/kg 10 mg/kg 20 mg/kg body weight) (=2 ml/kg) (=2 ml/kg) (=2 ml/kg) Time to inject 6 weeks 8 weeks 10 weeks after *All filtered through 0.22 μm filters before use

X-Ray Evaluation

The lumbar spines (L1-L6) were harvested and photographed using a digital camera. The harvested spines were faxitroned using a Faxitron® Machine (settings 24 kV for 45 seconds). Digital radiographs were taken in the posterior-anterior (PA) were graded for evidence of new bone formation and fusion by three blinded observers on the right and left sides. A qualitative grading system was used to assess the radiographs (Table 10). Fusion was assessed based on a continuous pattern of bone from one transverse process to the next level (0=non-continuous, 1-continuous). The amount of bone between the transverse processes on each side of the fusion masses was graded based on percentage as outlined in Table 10. The amount of TCP resorption was noted based on a comparison to time 0 radiographs with the same amount of material.

TABLE 10 Radiographic grading parameters Fusion Yes = 1 No = 0 Amount of bone 5 80-100%  4 60-80% 3 40-60% 2 20-40% 1  0-20%

Posteroanterior radiographs of all animals were taken post-operatively, at 4 weeks, and at 12 weeks following harvest. Representative Xrays of each group are shown in FIGS. 4-9. Granules were evident in post-operative Xrays for Groups 1, 2, 3, 4, 5 and 6. At the four-week time point, few granules were visible for Group 1 and 2, though their presence could be noted. More granules were apparent in Group 3 and 4, while Group 6 clearly showed remaining particles or granules. At 12 weeks, particles or granules could not be distinguished from bone for Groups 1, 2 and 3. Group 4 showed little bone formation and no clearly visible particles. Particles were still evident at 12 weeks for Group 6.

Radiographic assessment was performed by 3 blinded observers. The grading consisted of a binomial assessment of fusion and a 5-level assessment of the amount of bone present within the fusion mass. Results are shown in Table 11. The mean value of individual grades for each animal were first calculated, then the mean and standard deviation for each group was calculated.

TABLE 11 Pooled results of grading showing mean and (standard deviation) Group Left Fusion Right Fusion Left Bone Right Bone 1 0.777(0.17)  1(0) 4.83(0.27) 4.11(0.68) 2 0.777(0.40) 0.833(0.40) 3.50(1.09) 4.22(0.75) 3 0.666(0.51) 0.833(0.40) 3.44(1.40) 3.06(1.25) 4 0.222(0.40) 0.166(0.40) 1.11(0.17) 1(0) 5 0.277(0.44) 0.611(0.38) 3.06(1.28) 3.06(1.25) 6  1(0)  1(0) 4.78(0.17) 4.83(0.18)

Example 11: In Vivo Canine Segmental Ulnar Defect Study

Osteoinductive activity of a homodimeric protein (Hp) including a recombinant polypeptide produced according to Example 6 (i.e., SEQ ID NO: 260, including intramolecular C44-C48 and intermolecular C80-C112 and C79-C114 disulfide bonds) and porous beta-tricalcium phosphate (β-TCP) as a carrier material was evaluated in canine segmental ulnar defect model. The calcium phosphate carrier (e.g., β-TCP) had a calcium to phosphate ratio of about 0.7 to about 1.5, and the porosity of β-TCP was more than 70% with pore size from about 300 μm to about 600 μm.

Experimental Design

The protocol of this study was approved by the Nippon Veterinary and Life Science University Committee for Animal Experimentation. Animal experiments were carried out in accordance with the National Institutes of Health guidelines for the care and use of laboratory animals. 2.5-cm critical-size segmental ulnar defects were created in 15 forelegs of 8 dogs. In all cases, the diameter of the resected ulna was 7-8 mm, and the volume of the osteotomized ulna was approximately 0.96-1.26 cm³. At each defect site, 700 mg of artificial bone (β-TCP) was implanted with the homodimeric protein. The amount of homodimeric protein (0, 35, 140, 560, or 2240 μg) varied across each of 5 experimental groups (control, Hp 35, Hp 140, Hp 560, and Hp 2240, respectively). Each group consisted of 3 forelegs. Radiographic examination was performed every week after the operation, and computed tomography (CT) was performed every 4 weeks.

In alternative embodiments, at each defect site, 800 mg of artificial bone (β-TCP) was implanted with the homodimeric protein. The amount of homodimeric protein (160, 480, 640, or 1600 μg) varied across each of 4 experimental groups (Hp 160, Hp 480, Hp 640, and Hp 1600, respectively). Each group consisted of 3 forelegs. Radio-graphic examination was performed every week after the operation, and computed tomography (CT) was performed every 4 weeks.

Preparation of Implant Materials

The implant materials were composed of homodimeric protein and β-TCP (HOYA Corp., Tokyo, Japan). Freeze-dried homodimeric protein powder was reconstituted in sterilized distilled water (Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan) before use. Before implantation, 700 mg of β-TCP (approximately 1.89 ml) was soaked for 15 min at room temperature in 0.63 ml of distilled water containing 1 of the 4 doses of homodimeric protein. As a control, 700 mg of β-TCP soaked in 0.63 ml of plain distilled water was used. The individual β-TCP granules were 2-4 mm in diameter, with an interconnecting porous structure (pore size 50-300 μm, porosity 75%). This granule size is the most convenient for manipulation and tight implantation.

The implant volume, size of β-TCP granules, and volume of homodimeric protein solution were selected based on the results of pilot studies conducted prior to the experiment. Although the maximum implantation volume of β-TCP granules was determined to be 800 mg, 700 mg of β-TCP was used in this study due to inter-individual variability. Additionally, our pilot data indicated that 1.0 g of β-TCP granules could soak up as much as 1.0 ml of distilled water. To avoid the accumulation of residual fluid, 0.9 ml of homodimeric protein solution was used for per 1.0 g of β-TCP granules; thus, 700 mg of β-TCP granules was treated with 0.63 ml of the distilled water containing homodimeric protein.

Animal Model

All 8 dogs used in this study were healthy female 1-year old beagles with a body weight of 9.5-11.3 kg. The dogs were anesthetized via an intravenous injection of propofol (7 mg/kg); post-intubation, the anesthesia was maintained with isoflurane (1.5-2.0%) in oxygen. While the dogs were under general anesthesia, both their forearms were prepared and draped in a sterile environment. The lateral skin was incised longitudinally, and soft tissue was divided between the lateral digital extensor muscle and the ulnaris lateralis muscle to expose the ulna and the interosseous ligament. An oscillating saw was used to create the 2.5-cm segmental osteoperiosteal defects distally to the interosseous ligament. The periosteum around the bone defects was removed completely, and then the β-TCP granules were implanted tightly. The longitudinal length of the defects was about 3 times the perpendicular length, and represented a critical-size defect that does not heal spontaneously. After the β-TCP granules were implanted, the muscles were sutured using 3-0 absorbable monofilament sutures. The skin was closed using a 3-0 nylon monofilament suture. Perioperative analgesia was maintained by pre- and post-operative subcutaneous administration of buprenorphine (0.02 mg/kg), which was administered twice a day for 3 days after surgery. For 7 days after surgery, 25 mg/kg ampicillin was orally administered twice a day.

X-Ray and CT Examination

Lateral view X-rays of the dogs' forelegs were collected prior to, immediately after, and once a week for 12 weeks after the operation. An aluminum plate (25 mm×74 mm) was exposed with the forelegs to standardize the magnification and contrast difference in each X-ray image. The width of the regenerated bone was measured at the middle section.

To measure the cross-sectional area and mineral density of the regenerated bone, CT imaging (Asteion; Toshiba Medical Systems Corp., Tochigi, Japan) was performed immediately after, and at 4, 8, and 12 weeks after surgery while the dogs were maintained under general anesthesia. Multiplanar reconstruction (MPR) mode was used for examination. Twenty-five 1-mm-thick slices were reconstructed in the defect with correct alignment, and the thirteenth slice was defined as the objective center slice for measurement. The window width and window level were set at 1500 and 300 HU (Hounsfield units). The cross-sectional area was measured by manually surrounding the outline of the regenerated bone. Quantitative CT (QCT) was used to measure bone mineral density in the transverse plane. QCT is a volumetric method that estimates the milligrams of hydroxyapatite per cubic centimeter of bone tissue. Slice thickness was maintained at 1 mm, and a calibration phantom was scanned with the forelegs. The mean CT number value (HU) in the specified region of interest (ROI, diameter=5.5 mm) was determined at the center of the regenerated bone and the calibration phantom (B-MAS200; Kyoto Kagaku Co. Ltd, Kyoto, Japan), after which the mean bone mineral density was calculated.

Results are presented as mean (SD). A two-way repeated-measures ANOVA was used to investigate the effects of the different homodimeric protein-dose treatments; differences among the means were analyzed with Tukey-Kramer's post hoc tests. Significance was defined as P<0.05.

Results

FIGS. 10a-y are radiographs showing the post-operative change in each group. One week after surgery, only 2 cases (1 each from the Hp 2240 and Hp 560 treatment groups) showed slight radiopaque callus lines around the donor site. Two weeks after surgery, remarkable callus formation was observed in all cases from the Hp 2240 and Hp 560 treatment groups. In the former, the massive callus possessed irregular outlines and included the distal and proximal parts of the ulna (FIG. 10b ). In the latter, the radiopaque callus line was observed just around the donor site (FIG. 10g ). One case from the Hp 140 group displayed slight radiopaque callus lines around the donor site. No callus formation was observed in the Hp 35 and control groups (FIG. 10q, 10v ).

Four weeks after surgery, all cases in the Hp 2240 and Hp 560 treatment groups possessed radiodense, well-demarcated callus formation, and the borderline between the implant materials and the host bone was almost unclear; the granularity of the implanted materials had disappeared in all cases within both treatment groups (FIG. 10c, 10h ). The callus expansion areas were larger among Hp 2240 cases than Hp 560 cases. In the Hp 140 group, there was minor callus formation around the implanted materials in 1 case only. However, the granularity of the implanted materials had disappeared in all cases (FIG. 10m ). No callus formation was observed in the Hp 35 group, and the granularity of the implanted materials had disappeared in only 2 cases (FIG. 10r ). In all cases of the control group, no visible changes were observed in the center area, but a slight reduction of the mineral density was seen in the proximal and distal part of the grafted materials. Widening of the gap between the proximal ulna and implanted materials was also observed in these cases (FIG. 10w ).

Eight weeks after surgery, the remodeling process had progressed in the Hp 2240 and Hp 560 groups, with the outline of the callus having changed to fit the shape of the host bone (FIG. 10d, 10i ). In the Hp 2240 group, the borderline between the regenerated bone and the host bone disappeared in 2 cases at the proximal side, and in all cases at the distal side (FIG. 10d ). In the Hp 560 group, the borderline disappeared only at the distal side in all cases (FIG. 10i ). Although 1 case in the Hp 140 group displayed a disappearance of the borderline at the distal side, all others possessed well-demarcated gap lines at both sides of the bone (FIG. 10n ). There were no connections on either side between the regenerated bone and the host bone in the Hp 35 group (FIG. 10s ). In the control group, the β-TCP granules had been resorbed and the radiolucent area had increased noticeably (FIG. 10x ).

Twelve weeks after surgery, all cases in the Hp 2240 group showed a much larger and wider bone regeneration (FIG. 10e ). The radiolucent borderline between the regenerated bone and the host bone disappeared at both sides in 2 cases, but a slight borderline remained at the proximal side in 1 case. In all cases of the Hp 560 group, the borderline disappeared at the distal side (FIG. 10j ). A narrow borderline was present at the proximal side, but it was covered by callus. The width of the regenerated bone was larger than that of the proximal end of the ulna (FIG. 10j ). In one case in the Hp 140 group, the borderline disappeared at the distal side, but remained at the proximal side; the borderlines were present at both the sides in the other 2 cases (FIG. 10o ). The width of the regenerated bone was almost equal to or less than that of the proximal end of the ulna (FIG. 10o ). There were no cases in the Hp 35 group where the regenerated bone connected to the host bone; visible radiolucent gap lines were present along both sides of the bone in all cases (FIG. 10t ). The width of the regenerated bone was much smaller than that of the proximal end of the ulna (FIG. 10t ). No bony tissue was regenerated at the donor sites in the control group, and the β-TCP granules had resorbed even further since the previous examination (FIG. 10y ). Example 12: In Vivo Osteoinductive Activity in Sheep Interbody Fusion Model

Osteoinductive activity of a homodimeric protein including recombinant polypeptides produced according to Example 6 (i.e., SEQ ID NO: 260, including intramolecular C44-C48 and intermolecular C79-C112 and C80-C114 disulfide bonds), porous beta-tricalcium phosphate (β-TCP) as a carrier material and a peek cage as an accommodator was evaluated in an interbody fusion model in sheep. The calcium phosphate carrier has a calcium to phosphate ratio of about 0.7 to about 1.7.

Pre-Surgery Preparation

Animals (Species: Ovis Aries; Breed: Border Leicester Merino Cross; Source: UNSW approved supplier—Hay Field Station, Hay, NSW and animals were purchased following UNSW Animal Care and Ethics Committee approval; Age: 4 years old age; and Gender: Female (Ewe)) were prepared for surgery according to standard operating procedures. Twenty-four hours prior to surgery, pre-emptive analgesia was administered, by applying a transdermal fentanyl patch (100 mg-2 mcg/kg/hr) to the right foreleg of each animal (left foreleg was used for iv line). Prior to application, the wool was clipped and the skin cleaned with alcohol swabs to ensure adequate absorption. Animals were fasted and water withheld a minimum of 12 hours prior to surgery.

Surgery

Sheep allocated to the study were randomly selected on the day of surgery. Once a sheep was selected it was assigned a number and ear-tagged according to standard operating procedures. This identification number was recorded in the study notebook.

On the day of surgery and prior to commencement, the Study Veterinarian examined each animal to ensure that it was free of disease or any condition that might interfere with the purpose or conduct of the study. Notes were made in the Study Notebook against the animal number as to the condition of each animal and its suitability for inclusion in the study.

Animals were induced, anaesthetised, maintained, and monitored during the procedure according to standard operating procedures. The left foreleg was used for cephalic intravenous access. Blood was taken for pre-operative analysis according to standard operating procedures, prior to i.v. administration of Hartman's solution. Blood samples were labelled “PRE-OP” along with study ID, animal number and date and sent to IDEXX Australia for routine biochemistry (4 ml) and haematology (4 ml).

Surgery was performed according to a modified version of standard operating procedures.

Surgical Procedure—L45 XLIF+Pedicle Screws

Prior to surgery, all animals were under food restriction (NPO) for forty-eight hours and housed in the isolation pen care facility. Following administration of anesthetic medications and induction of general anesthesia, the posterior lumbar region, iliac crest and proximal tibia were aseptically prepared.

Graft Mixing Procedure

The homodimeric protein (10 mg/vial) was dissolved in 0.3 mL distilled water to make a 33.3 mg/mL HP stock solution A. A block of β-TCP (approx. 150 mg) was placed into an interbody cage. For each group, “Hp solution” that was diluted or divided from HP stock solution A was dropped evenly across the block of β-TCP (approx.150 mg) placed on a sterilized Petri dish. After the fluids were completely dropped, the block of β-TCP was allowed to stand for more than 15 minutes at room temperature before implantation.

Group A-F used the above-described homodimeric protein (Hp) combined with β-TCP carrier as graft material, with the homodimeric protein dose per site shown in Table 12. Preparations of mixing procedures were as follows.

TABLE 12 Carrier Hp Pedicle Time Group Animal βTCP mg/site Level Cage screws point A 1 150 mg 4.0 mg L45 Yes Yes 12 wks B 2 150 mg 2.0 mg L45 Yes Yes 12 wks C 3 150 mg 1.0 mg L45 Yes Yes 12 wks D 4 150 mg 0.5 mg L45 Yes Yes 12 wks E 5 150 mg 0.1 mg L45 Yes Yes 12 wks F 6 150 mg   0 mg L45 Yes Yes 12 wks G 7 150 mg Autograft L45 Yes Yes 12 wks (iliac crest) A 8 150 mg 4.0 mg L45 Yes Yes 12 wks B 9 150 mg 2.0 mg L45 Yes Yes 12 wks C 10 150 mg 1.0 mg L45 Yes Yes 12 wks D 11 150 mg 0.5 mg L45 Yes Yes 12 wks E 12 150 mg 0.1 mg L45 Yes Yes 12 wks F 13 150 mg   0 mg L45 Yes Yes 12 wks G 14 150 mg Autograft L45 Yes Yes 12 wks (iliac crest) X 15 150 mg   0 mg L45 Yes Yes  0 wks

For group A, Hp 4 mg/site: Prepared Hp stock solution A (33.3 mg/mL) by adding 0.3 mL injection water to each of the glass vials with 10 mg homodimeric protein in it as Hp stock solution A. Put a β-TCP block (approx. 150 mg) into the peek cage. Delivered 120 μL Hp stock solution A by drops evenly into 150 mg β-TCP block.

For group B, homodimeric protein 2 mg/site: Mixed water and Hp stock solution A in a 1:1 volume:volume ratio, then obtained Hp solution B (16.7 mg/mL). Put a β-TCP block (approx. 150 mg) into the cage. Delivered 120 μL Hp solution B by drops evenly into 150 mg β-TCP block.

For group C, homodimeric protein 1 mg/site: Mixed water and Hp stock solution B in a 1:1 volume:volume ratio, then obtained Hp solution C (8.3 mg/mL). Put a β-TCP block (approx. 150 mg) into the cage. Delivered 120 μL Hp solution C by drops evenly into 150 mg β-TCP block.

For group D, homodimeric protein 0.5 mg/site: Mixed water and Hp stock solution C in a 1:1 volume:volume ratio, then obtained Hp solution D (4.2 mg/mL). Put a β-TCP block (approx. 150 mg) into cage. Delivered 120 μL Hp solution D by drops evenly into 150 mg β-TCP block.

For group E, homodimeric protein 0.1 mg/site: Mixed water and Hp stock solution D in a 1:4 volume:volume ratio, then obtained Hp solution E (0.8 mg/mL). Put a β-TCP block (approx. 150 mg) into cage. Delivered 120 μL Hp solution E by drops evenly into 150 mg β-TCP block.

For group F, homodimeric protein 0 mg/site: Put a β-TCP block (approx. 150 mg) into cage. Delivered 120 μL water by drops evenly into 150 mg β-TCP block.

Interbody Peek Cage

The transverse processes were palpated to identify the appropriate spinal levels. The level was verified by fluoroscopy. Caspar pins were placed into the L4 and L5 vertebral bodies and a Caspar retractor used to distract the disc space. The disc was removed with sharp dissection and curettes and the endplates prepared. The interbody device filled with the graft material was carefully placed into the disc space and the retractors released. The soft tissues were re-apposed and the skin closed in layers.

FIG. 11 shows the appearance of an interbody cage.

Pedicle Screws

Following completion of the XLIF, the animal was repositioned in the prone position and draped using sterile technique; an initial skin incision was made in the dorsal mid-line of the low back centered over the L3-S1 levels. Blunt dissection using a Cobb elevator and electrocautery, when necessary, was performed in the sagittal plane along the neural arch—permitting exposure of the L45 facets and transverse processes and insertion of pedicle screws and rods at this level.

Radiographs were taken immediately following surgery in the postero-anterior plane using a mobile x-ray machine (POSKOM) and digital cassettes (AGFA). The data were stored in DICOM format and exported to JPG images using ezDICOM medical viewer software. This is performed according to standard operating procedures.

Post-Operative Monitoring

Animals were monitored daily for the first 7 days and recorded. Animals were examined at least once daily for the duration of the study by veterinary technicians and recorded weekly. Any health concerns identified by the technicians were reported to the veterinary staff for further evaluation and management by the PI.

Sheep were monitored as per the study site standard operating procedure. The surgical incision, appetite, changes in skin and hair, eyes and mucous membranes, respiratory system, circulatory system, posture/gait, behaviour patterns (occurrence of tremors, convulsions, excess salivation, and lethargy) were monitored daily for the first post-operative week and weekly thereafter. Signs monitored thereafter were alertness/attentiveness, appetite, and surgical site, appearance of eyes, ambulation, and ability to keep the head raised. Criteria for intervention were signs of infection.

Post-operatively, animals received oral antibiotics (Kelfex) and analgesics (buprenorphine, 0.005-0.01 mg/kg IM) for the first 3 days. Daily neurological assessments were made for the first 7 days post-operatively. Post-operative pain relief was provided thereafter based on clinical monitoring.

Explant

At the designated time point, each animal had its identification number confirmed before being induced and anaesthetized, as per standard operating procedures.

After anaesthetic induction, blood was taken from either the jugular or cephalic vein, according to standard operating procedures. Samples were labelled “with study ID, animal number and date. The samples were transported to SORL in a sealed biohazard bag and maintained below 30 degrees C. and sent to IDEXX Australia for Routine biochemistry (4 mLs) and haematology (4 mLs). Transportation times were noted in the notebook.

While still under an anesthesia, animals were euthanized by lethal injection of Lethobarb according to standard operating procedures. The carcass was transported immediately to SORL and kept at a temperature of less than 30 degrees C.

Each animal was examined and dissected according to standard operating procedures. The Lumbar Spine was harvested and photographed using a digital camera. The surgical sites were examined for signs of adverse reaction or infection and the results noted and photographed.

Immediately after harvest, the stability of the fusion mass was assessed by manual palpation in all animals 12 weeks. Two trained and experienced blinded observers worked together to assess the fusion mass in lateral bending and flexion-extension with the pedicle rods intact as well as removed.

The fusions were graded as either fused (rigid, no movement) or not fused (not rigid, movement detected) when manual palpation evaluated in lateral bending on the right and left sides and flexion-extension at the treated level. The mobility of the untreated level was used as a relative comparison at the time of manual palpation when evaluated in lateral bending on the right and left sides as well as flexion-extension.

Range of Motion (ROM) Testing

The L45 segments were carefully harvested from the spine. A 4 mm×15 mm screw was inserted into the vertebral bodies and used to assist in potting the samples.

The segments were carefully potted in a resin for ROM evaluation. Range of motion in flexion-extension (FE), lateral bending (LB) and axial rotation (AR) were determined using a Denso Robot. The rods were removed prior to testing. A 7.5 Nm pure moment will applied to the spines in FE, LB and AR and resulting angular deformation recorded with the testing equipment. Each loading profile were repeated 3 times and a mean value for FE, LB and AR obtained for each treated level as shown in FIG. 12. Samples were fixed in phosphate buffered formalin after mechanical testing for paraffin histology on one side and PMMA histology for the other side of the fusion as outlined below. ROM data were analysed using ANOVA using SPSS.

As shown in Table 13, manual palpation indicated non-rigid motion segments for doses below 0.5 mg, and rigid motion segments for doses of 0.5 mg and above, as well as for autograft.

TABLE 13 Manual Manual Time Palpation Palpation Group Animal ID Hp mg/site (weeks) FE* LB{circumflex over ( )} X 15 W2780   0 mg 0 not rigid not rigid F 6 W2781   0 mg 12 not rigid not rigid F 13 W2792   0 mg 12 not rigid not rigid E 5 w2790 0.1 mg 12 not rigid not rigid E 12 W2791 0.1 mg 12 not rigid not rigid D 4 W2788 0.5 mg 12 rigid rigid D 11 W2789 0.5 mg 12 rigid rigid C 3 W2786 1.0 mg 12 rigid rigid C 10 W2787 1.0 mg 12 rigid rigid B 2 W2784 2.0 mg 12 rigid rigid B 9 W2785 2.0 mg 12 rigid rigid A 1 W2782 4.0 mg 12 rigid rigid A 8 W2783 4.0 mg 12 rigid rigid G 7 W2793 Autograft 12 rigid rigid (Iliac Crest) G 14 W2794 Autograft 12 rigid rigid (Iliac Crest) *FE: Flexion extension {circumflex over ( )}LB: Lateral bending

As shown in FIG. 12, range of motion showed little change for any treatment in axial rotation. However, flexion extension decreased from intact for all treatment groups and showed a trend towards increased stability with increasing homodimeric protein dose. Autograft and 1.0 mg homodimeric protein were the most comparable. Lateral bending was reduced for all treatments as well, to <50% of the intact value for all treatments. Lateral bending also showed a reduction in ROM as with increasing homodimeric protein dose. The dose influence was most prevalent at the 0.1 mg to 0.5 mg stage.

Micro Computed Tomography—Spine

Micro Computed tomography (μCT) was performed on the spines using an Inveon Scanner (Siemens, USA). Slice thickness were set to approximately 50 microns for all scans. CT scans were stored in DICOM format. Three dimensional models were reconstructed based and examined in the axial, sagittal, and coronal planes. The DICOM stacks were sent to the Study Sponsor for additional analysis.

Axial, sagittal and coronal images as well as anterior and posterior 3D models were provided for each animal. The micro-CT reconstructions were evaluated by reviewing the coronal and sagittal planes to examine fusions between the treated levels. The micro-CT were graded using the same Radiographic grading score (Table 14) considering the entire micro-CT stack by two trained and experienced observers blinded to treatment groups. Each fusion will also be graded with a scale of 1 to 4 representing the amount of bone qualitatively at the level: 0-25%, 2: 26-50%, 3: 51-75%, 4: 76-100%.

TABLE 14 Grading scale for micro CT Number Grade Description 0 No new bone No new bone formation visible 1 Visible new bone New bone formation visible but no continuous bone 2 Visible new bone Continuous bridging new bone with visible lucency 3 Probable fusion Continuous bridging new bone formation

Representative images of the micro-CT for each animal were prepared in three orthogonal planes as well as three dimensional models in the anterior and posterior views. Micro computed tomography (μCT) scanning were performed on all animals following radiography using a Siemens Inveon in-vivo microcomputer tomography scanner to obtain high resolution radiographic images of the spinal fusions in three planes. This was performed according to standard operating procedures; however, in addition thicker reconstructions were also be taken and examined for each animal using a 500 micron summation image technique. Note, the 3D reconstructions were reviewed to evaluate the overall fusion status and representative images were provided in the report and appendices for all animals. This was performed according to standard operating procedures. The sagittal and coronal CT images were reviewed and an overall grade for the fusion given based on Table 14. See FIGS. 13-15.

Fusion Grading

0 Hp mg/sites demonstrated residual TCP and some bone formation primarily at the endplate. With 0.1 Hp mg/site new bone was generated and minimal residual TCP was present but solid bone bridging was not present. With 0.5 Hp mg/site good bone quality was generated but with the presence of some lucent lines within the graft. With doses of 1.0 Hp mg/site and 2.0 Hp mg/site the inter-cage space was filled with good quality bone with minimal lucent areas. 4.0 Hp mg/site generated a high grade of bone based on volume; however, there was lucency within the bone including some large and small pockets. Autograft (iliac crest) demonstrated variable results with fair to good bone formation and areas of non-union. The following table summarizes the grading of each site.

Fusion grading based on Micro CT analysis were as shown in Table 15. Overall bone grade and fusion grade peaked with 1.0 and 2.0 mg Hp doses. Bone grade was graded with a scale of 1 to 4 representing the amount of bone qualitatively at the level: 0-25%, 2: 26-50%, 3: 51-75%, 4: 76-100%. Fusion grading was done from 0-3 based on 0-No new bone, 1-visible new bone, but not continuous, 2-possible fusion with lucency, 3-probable fusion with bridging bone.

TABLE 15 Group ID Hp mg/site Time Bone Fusion F W2781 0 mg 12 2 1 F W2792 0 mg 12 2 1 E w2790 0.1 mg 12 3 1 E W2791 0.1 mg 12 3 1 D W2788 0.5 mg 12 4 2 D W2789 0.5 mg 12 4 2 C W2786 1.0 mg 12 4 2 C W2787 1.0 mg 12 4 3 B W2784 2.0 mg 12 4 2 B W2785 2.0 mg 12 4 3 A W2782 4.0 mg 12 4 2 A W2783 4.0 mg 12 3 2 G W2793 Autograft(Iliac Crest) 12 4 2 G W2794 Autograft(Iliac Crest) 12 2 2

Example 13: Controlled Release System Preparation (Double Emulsion Method/Basic Substance/Hydrophilic Drug)

In one embodiment, 0.25 g of PLGA (Lactic acid/Glycolic acid ratio 65/35, MW 40000-75000, Sigma-Aldrich) dissolved in 2.5 mL of dichloromethane (Merck) was shaken with a shaker (1000 rpm) for 5 minutes to form a 10% PLGA solution (10% oil phase solution). 2.5 mL double-distilled water (DDW) was slowly mixed the 10% PLGA solution and stirred at 1,000 rpm for 15 minutes to form a first emulsion (w/o). The first emulsion was added to 10 mL of a 0.1% (w/v) polyvinyl alcohol (PVA) (MW˜13000, Fluka) second aqueous solution and stirred at 500 rpm and evacuated the gas for 5 minutes to form a second emulsion (w/o/w). The second emulsion was continuously stirred for 4 hours and then left standing for one minute. Particles in the pellet were collected by centrifugation at 4,000 rpm for 5 minutes. The particles were washed with 5 mL of DDW for minutes. After centrifugation and washing three times, centrifuged particles were collected and lyophilized 3 days to form PLGA microparticles. 2 mg and/or 4 mg β-TCP powder (Sigma-Aldrich) was mixed with 504 DDW and 10 μg of the homodimeric protein (Hp) including recombinant polypeptide produced according to Example 6 (i.e., SEQ ID NO: 260) to form a slurry. The slurry was then mixed or coated on the surface of 50 mg PLGA microparticles and lyophilized 3 days to form PLGA microparticles, one of the controlled release system. In certain embodiments, the lyophilized controlled release system could be pressed to form a flat piece.

In alternative embodiment, 2.5 mL dichloromethane was mixed with 0.25 g of poly lactic-co-glycolic acid, PLGA 65:35 (Supplier, Sigma) and stirred (1000 rpm) for 5 minutes which became a 10% oil phase solution (P1). 0.25 mL of double-distilled water (DDW) was added into P1 and stirred (1000 rpm) for 15 minutes which became first emulsion phase (w/o, P2). The P2 was placed into 10 mL of 0.1% (w/v) polyvinyl alcohol (PVA) (MW˜13000, Fluka) and stirred (500 rpm) for 4 hours (P3). Centrifugation of P3 at 4,000 rpm for 5 minutes, the supernatant was discarded, and the residual solution was collected. 5 mL of PBS was added into P3 and repeat for three times, the residual solution was collected and lyophilized. The lyophilized powder of PLGA microsphere was weighted, and the production rate (%) was calculated. The 0.06 mL of DDW was mixed with 2 mg of β-TCP powder (Sigma-Aldrich), then 20 μg of the homodimeric protein was added into β-TCP for stirring 5 minutes. After that, 50 mg of PLGA microsphere was added into the mixture and stirred evenly. The microsphere containing was lyophilized and pressed a tablet with a size Φ10 mm. (The appropriate pressure was 5˜10 Kg).

In some embodiments, the 2 mg and/or 4 mg β-TCP powder could be replaced with either 4 mg tricalcium phosphate (TCP) or 1 mg alpha-tricalcium phosphate (α-TCP). In certain embodiments, the PLGA65/35 could be replaced with PLGA50/50, polylactic acid (PLA) or polyglycolic acid (PGA).

Evaluation of Homodimeric Protein (Hp) Release from PLGA/Hp-β-TCP

100 mg of PLGA/Hp-β-TCP was soaked in 1 mL human serum, and shaken with 60 rpm at 37° C. Human serum solution containing released homodimeric protein was collected at 15 min, 1 hour, day 1, 2, 3, 7, 10 and 14, and at each time point was replaced with 800 μL of fresh human serum. The collected human serum was stored at −80° C. and all samples were analyzed simultaneously with a direct ELISA assay.

The release profile of the PLGA microparticles coated with β-TCP and the homodimeric protein is shown in FIGS. 16a and 16b . Homodimeric protein physically adsorbed on the surface of the PLGA microparticles was shown to continuously release therefrom to an in-vitro solution via diffusion and PLGA hydrolysis. Results from an ELISA kit showed that 17% and 31.5% of relative amount of homodimeric protein was released at 15 min and 1 hr, respectively. The relative releasing percentages of homodimeric protein were 14.5% (at 60 min to day 1), 14.3% (day 1 to day 2), 7.6% (day 2 to day 3), 9.3% (day 3 to day 7), 5.4% (day 7 to day 10) and 0.4% (day 10 to day 14) and that has shown a slow-release pattern. This formulation of PLGA/Hp-β-TCP alleviated the common issue of burst release [Giteau et al., Int J Pharm 350:14 (2008)]; most delivery systems deliver a burst release during the first few hours, often releasing over 60% of the encapsulated/surface bound product [Woodruff et al., J Mol Histol 38:425 (2007) and Sawyer et al., Biomaterials 30:2479 (2009)].

FIG. 17 shows morphology and a diameter distribution of the PLGA microparticles under an electron microscope. The PLGA microparticles were globular and had a diameter distribution ranging from 100 μm to 150 μm.

In another embodiment, 2 g of PLGA was dissolved in 20 mL of dichloromethane (DCM) to form a 10% PLGA/DCM solution. Biphasic calcium phosphate (BCP) powder was dispersed in water to form an aqueous solution. The aqueous solution was then mixed with the PLGA/DCM solution and stirred with a magnetic stirrer for 30 minutes to form an emulsion. Next, the emulsion was fed into a granular machine to perform a spray granulation process to form PLGA microparticles.

Evaluation the New Bone Formation of PLGA/Hp-β-TCP on Balb/C Mice Osteonecrosis Model

Surgery Procedure

In the animal osteonecrosis model, in order to simulate the real osteonecrosis situation, the whole tibia periosteum was stripped. A 2 mm length of the mid-shaft of the tibia on the right side of a mouse was cut out with a saw. The cut surface of the bone was frozen using liquid nitrogen for 5 min to mimic necrotic bone. Next, the fragment was reversed and put back to its original site in the tibia and fixed to both ends with the other parts of the tibia by using a syringe needle (No. 26) as an intramedullary fixation. After a test article was placed around the bone fracture, the wound was closed with silk sutures. The mice were divided into six groups, including necrotic bone control (C), PLGA/β-TCP (PT), PLGA/0.2 μg Hp-β-TCP (POT-0.2), PLGA/0.8 μg Hp-n-TCP (POT-0.8), PLGA/1.6 μg Hp-3-TCP (POT-1.6) and PLGA/3.2 μg Hp-β-TCP (POT-3.2) groups. Three to six mice in each experimental group were observed at 4 weeks after surgery.

Soft X-Ray Observation

At 4 weeks after the operation, the tibia bone fractures were radiographically examined by soft X-rays (SOFTEX, Model M-100, Japan) at 43 KVP and 2 mA for 1.5 s. The appropriate magnification was applied throughout the observation period, and the resultant micrographs were compared among all carriers together with controls.

FIG. 18 shows the X-ray photographs of mice tibia osteonecrosis fragment callus formation at 4 weeks after implantation of PLGA/Hp-β-TCP containing different homodimeric protein doses compared to control (C) or PLGA/β-TCP (PT) groups. An incomplete fusion was noted in control group, and a small gap was existed in osteonecrosis region in PT group. Clear fusion masses were observed in POT-0.2, POT-0.8, POT-1.6 and POT-3.2 groups. The results indicated that the efficacy of bone repair on PLGA/Hp-β-TCP groups were greater than control and PT groups.

Histological Analysis of Bone Tissue

Histochemical analyses were concurrently employed to assess the microscopic changes in the bone tissue. Prior to hematoxylin-eosin (H&E) staining, all samples of bone tissue were decalcified using 0.5% EDTA. The resultant samples were embedded into paraffin wax, and 5 μm sections were prepared. Sections were routinely stained with H&E and observed with a microscope. At 400× magnification, the callus area was compared with that of the control group.

As shown in FIG. 19, the new bone formation was evaluated after 4 weeks of implantation of PLGA/Hp-β-TCP (POT). The bone formation rate of the PLGA/β-TCP (PT) group show a similar result as compared to the control group. Bone formation rate was enhanced in the POT groups as compared to the PT and control groups, which was increased in a dose-dependent manner except for the POT-3.2 group. These results demonstrated potential advantages of homodimeric protein controlled-release carriers that can induce bone regeneration on Balb/C mice osteonecrosis model.

Example 14: Sustained Release System Putty Preparation

Powders were prepared and mixed according to the formulas in Table 16. The powders were stored at 4° C. overnight. On the day that the putty was prepared, all materials (i.e., the powder, β-TCP, glycerol and deionized water) were illuminated with UV light for 20 minutes. According to the animal experimental bone defect range of 2×0.5×0.5 cm, putty weights of about 0.9 g were prepared in accordance with the formulas as shown in Table 16.

TABLE 16 Putty formulation Formula A Formula B Formula C Formula D Formula E Formula F Formula G Powder CaSO₄ · 1/2H₂O ^(*1) — 96% 96% 96% 96% — — 0.864 g 0.864 g 0.864 g 0.864 g CaSO₄ · 2H₂O^(*2) — — — — — 48% 48% 0.432 g 0.432 g HPMC^(*3) — 4% 4% 4% 4% 4% 4% 0.036 g 0.036 g 0.036 g 0.036 g 0.036 g 0.036 g Ca₃(PO₄)₂ ^(*5) — — — — — 48% 48% 0.432 g 0.432 g Liquid Glycerol^(*7) — 126 μl 126 μl 126 μl 126 μl 252 μl 252 μl Hp^(*4) — — 40 μl of 40 μl of — 40 μl of 40 μl of 0.5 mg/ml 0.25 mg/ml 0.25 mg/ml 0.5 mg/ml Deionized water — 54 μl 14 μl 14 μl 54 μl 68 μl 108 μl L/P (Liquid/powder) — 0.2 0.2 0.2 0.2 0.4 0.4 β-TCP^(*6) (2-3 mm) 50 mg 50 mg — 50 mg 50 mg 50 mg — Hp^(*4) 160 μl of 40 μl of — 40 μl of 40 μl of 40 μl of — 0.125 mg/ml 0.5 mg/ml 0.25 mg/ml 0.5 mg/ml 0.25 mg/ml Cross-section See Figure See Figure See Figure See Figure See Figure See Figure See Figure 20A 20B 20C 20D 20D 20D 20C ^(*1) Calcium Sulfate Hemihydrate (MT3, Taiwan), ^(*2)Calcium Sulfate Dihydrate (J.T. baker, USA), ^(*3)Hydroxypropyl Methylcellulose (Sigma-Aldrich, USA), ^(*4)Homodimeric protein (Hp) including recombinant polypeptide produced according to Example 6 (i.e., SEQ ID NO: 260) final volume 20 μg, ^(*5)Calcium Phosphate (Sigma-Aldrich, USA), ^(*6)Tricalcium Phosphate Beta Form (Wiltrom, Taiwan), ^(*7)Glycerol (Showa, Japan) Formula A: 160 microliters of 0.125 mg/mL Hp solution was dripped in approx. 50 mg β-TCP, in sterile conditions, and allowed to adsorb for 15 minutes. Formula B: 40 microliters of 0.5 mg/mL Hp solution was dripped in approx. 50 mg β-TCP, in sterile conditions, and allowed to adsorb for 15 minutes. Powder and liquid (as shown in Table 16 for Formula B) and previously prepared β-TCP granules were mixed together and molded. Formula C: Powder and liquid (as shown in Table 16 for Formula C) were mixed evenly. Formula D: 40 microliters of 0.25 mg/mL Hp solution was dripped in approx. 50 mg β-TCP, in sterile conditions, and allowed to adsorb for 15 minutes to form Hp/β-TCP granules. Powder and liquid (as shown in Table 16 for Formula D) were mixed together to form a matrix and the matrix was molded in a specific shape. Hp/β-TCP granules were evenly distributed in the outer layer of the matrix. Formula E: 40 microliters of 0.5 mg/mL Hp solution was dripped in approx. 50 mg β-TCP, in sterile conditions, and allowed to adsorb for 15 minutes to form Hp/β-TCP granules. Powder and liquid (as shown in Table 16 for Formula E) were mixed together to form a matrix and the matrix was molded in a specific shape. Hp/β-TCP granules were evenly distributed in the outer layer of the matrix. Formula F: 40 microliters of 0.25 mg/mL Hp solution was dripped in approx. 50 mg β-TCP, in sterile conditions, and allowed to adsorb for 15 minutes to form Hp/β-TCP granules. Powder and liquid (as shown in Table 16 for Formula F) were mixed together to form a matrix and the matrix was molded in a specific shape. Hp/β-TCP granules were evenly distributed in the outer layer of the matrix. Formula G: Powder and liquid (as shown in Table 16 for Formula G) were mixed evenly.

Sample Preparation

Formula putty shown in Table 16 were placed in 15 ml tube. Putty with or without β-TCP soaked with Hp was placed in 3 mL human serum, and allowed to stand at 37° C., under 5% CO₂. Human serum solution containing released Hp was collected at initial, 1 hour, Day 1, 2, 3, 7, 10, 14 and 21, and at each time point was replaced with 2500 μL of fresh human serum. The collected human serum was stored at −80° C. and all samples were analyzed simultaneously with a direct ELISA assay within the day.

OIF Quantification

To quantify the total concentration of homodimeric protein, an in vitro release test was used. Homodimeric protein concentrations in the human serum were quantified using ELISA-methods (the assay was obtained from inVentive Health clinical systems, USA). The analyses were performed according to the instructions of the manufacturer. Briefly, samples, QC samples and standards were added to 107 capture antibody (generated from Pharma Foods International Co., Ltd.) coated 96 well plates. After incubation and removal of the unbound substances, HRP-I07detection antibody was added. This step was followed by a further washing step and incubation with a substrate. The color reaction was stopped and the optical density measured at the appropriate wavelength. The concentration of homodimeric protein was back calculated off of the non-linear regression of the standard deviations.

The purpose was to evaluate the release of homodimeric protein from a bioresorbable osteoconductive composite such as beta-TCP or putty, and to assess its suitability for bone regeneration. Homodimeric protein released from formula A was observed to have a burst release profile at the beginning, but after the burst period (around 0 to 1 hour) a slow-release pattern as shown in FIG. 21 was observed. Compared with formula A, the homodimeric protein in formula B and C was wrapped up by putty or the matrix, so that it cannot be released at the beginning hours. In contrast, when homodimeric protein contained in β-TCP granules covered distributed on the surface of the putty or the matrix, such as formula D, a sustained release effect was achieved. It was known that putty was a bone graft substitute with a proven ability to accelerate bone regeneration. The composition of the putty determines plasticizing capacity, hardening or curing. Thereafter, different proportions of the formulation, for example, the choice of calcium sulfate dihydrate or calcium sulfate to prepare putty could achieve sustained release of the dosage form.

The development of bone substitute materials trends toward materials that are bio-absorbable, osteoconduction, osteoinduction, as well as biocompatible. In other words, the direction of development for composite bone defect filling material is a material that is multi-functional. In the designed putty, pores can be generated in the bone substitute for ingrowth of bone cells, while homodimeric protein can be released over a long term for induction of osteoclasts and activation of osteocytes in the slow process of material decomposition. Therefore, the healing of bone defects will be effectively accelerated.

Example 15: Clinical Study Design

Study Design 1

A Randomized, evaluator-blind, controlled study investigating the efficacy and safety of three dosage levels of the homodimeric protein (Hp) including recombinant polypeptide produced according to Example 6 (i.e., SEQ ID NO: 260)/β-TCP in treatment of open tibial fractures with need of bone grafting will be performed. A total of approx. 35 patients having initial open tibial fractures (Gustilo type IIIA or IIIB) will participate in the study and will be divided (randomized) into four groups and one control group (approx. 5 patients), each of the other groups consisting of approx. 10 patients (vide infra). A vial contains 5.5 mg lyophilized power of homodimeric protein. After reconstitution (the exact volume of water used to get the intended concentration will be stated as in Table 17), the reconstituted homodimeric protein will be mixed with the β-TCP to make the final concentration of 1.5 mg/g (Group 2), 2 m g/g (Group 3) or 3 mg/g (Group 4) the Hp/β-TCP, then certain amount of these mixture will be applied to the fracture site within 3 months after the fracture occurred. Patients in the control group (Group 1) will receive autogenous bone graft but lacking the homodimeric protein and/or β-TCP. Subjects will be followed for efficacy and safety for the main study period of 30 weeks and an extension safety follow-up to 52 weeks after definitive treatment. In some embodiments, the total amount of β-TCP used is based on the physician's judgment and adjustment.

TABLE 17 Hp Hp WFI Concentration Hp Volume β-TCP Final Concentration Applied (mg/vial) (mL) (mg/mL) required (mL) required (g) (Hp (mg)/β-TCP (g)) 5.5 3.0 1.8 2 2.4 1.5 (Group 2) 5.5 2.3 2.4 2 2.4 2.0 (Group 3) *5.5 × 2 1.5 × 2 3.6 1 × 2 2.4 3.0 (Group 4) [Two vials (1.5 ml for each (1 ml from each of Hp) Hp vial) vial, total 2 ml) *For final concentration 3.0 mg/g (Hp/β-TCP), 2 vials of lyophilized powder will be mixed with 1 vial β-TCP; each vial of lyophilized powder will be reconstituted by 1.5 ml WFI; and 1 ml from each reconstituted Hp (total 2 ml) will be mixed with 1 vial (2.4 g) β-TCP.

Patient Inclusion/Exclusion Criteria

Subjects will be included if ALL of the following Inclusion Criteria apply:

The subject is ≥20 years old;

Females of non-childbearing potential or who have a negative result on pregnancy test within 72 hours prior to surgery, or males;

Initial open tibial fractures (Gustilo type IIIA or IIIB) and bone graft within 3 months of fracture;

In bilateral open tibial fractures, the random treatment assignment is for the right tibia;

Definite therapy is performed within 3 months after the initial injury; and

Female subjects of childbearing potential (i.e., women who have not been surgically sterilized or have not been post-menopausal for at least 1 year) and male subject's partners of childbearing potential must agree to use medically acceptable contraception methods throughout the study period. Medically acceptable contraception methods include hormonal patch, implant or injection intrauterine device, or double barrier method (condom with foam or vaginal spermicidal suppository, diaphragm with spermicidal). Complete abstinence can be considered an acceptable contraception method. Oral contraceptive is an acceptable contraception method prior to the study, but an alternative method will be required during the study;

Subjects will be excluded if ANY of the following Exclusion Criteria apply:

Head injury with initial loss conscious;

Purulent drainage from the fracture, or evidence of active osteomyelitis;

Compartment syndrome;

Pathological fractures; history of Paget's disease or other osteodystrophy; or history of heterotopic ossification;

Endocrine or metabolic disorder that affects osteogenesis (e.g., hypo- or hyper-thyroidism or parathyroidism, renal osteodystrophy, Ehlers-Danlos syndrome, or osteogenesis imperfecta)

Has abnormal renal and/or hepatic functions, with Creatinine or ALT value>5 times the upper normal limit;

History of malignancy, radiotherapy, or chemotherapy for any malignancy within the last 5 years;

An autoimmune disease (e.g. Systemic Lupus Erythematosus or dermatomyositis);

Previous exposure to rhBMP-2;

Hypersensitivity to protein pharmaceuticals, e.g, monoclonal antibodies, gamma globulins, and tricalcium phosphate;

Treatment with any investigational therapy within 28 days of implantation surgery;

Treatment for 7 days or more with prednisone (cumulative dose>150 mg within 6 months or other steroids with equivalent dose, refer to Appendix 1), calcitonin (within 6 months). Treatment of Bisphosphonates (for 30 days or more within 12 months), therapeutic doses of fluoride (for 30 days within 12 months);

The female subject who is lactating; and

Any condition that is not suitable to participate in the study based on the physician's judgement.

Assessments of Efficacy Primary Endpoint:

The primary study efficacy endpoint is the proportion of subjects who received secondary intervention within 30 weeks after definitive wound closure.

Secondary Endpoints:

The proportion of subjects who received secondary intervention within postoperative Week 6, Week 12, Week 18, Week 24, Week 42 and Week 52 after definitive wound closure;

Time from definitive wound closure to secondary intervention;

Rate of clinical fracture healing within postoperative Week 6, Week 12, Week 18, Week 24, Week 30, Week 42 and Week 52 after definitive wound closure;

Time from definitive wound closure to clinical fracture healing;

Rate of radiographic healing within postoperative Week 6, Week 12, Week 18, Week 24, Week 30, Week 42 and Week 52 after definitive wound closure;

Time from definitive wound closure to radiographic healing;

The term “secondary intervention” is in relation to any procedure that is performed or any occurrence of an event that has the potential to stimulate fracture healing, including but not limited to bone graft, exchange nailing, plate fixation, nail dynamization, ultrasound, electrical stimulation, or magnetic field stimulation or others that might promote healing.

The term “clinical fracture-healing” refers to the absence of tenderness on manual palpation from fracture site. In some embodiments, the term “clinical fracture-healing” refers to no or mild pain (pain score 0-3) at the fracture site with full weight-bearing and pain will be documented using the visual analogue scale.

The term “radiographic fracture healing” refers to a condition that in view of the anteroposterior and lateral radiographs, investigators and/or an independent radiologist identified Cortical bridging and/or disappearance of the fracture lines on 3 cortices of the 4 cortices at fracture site.

Assessment of Methods Safety Assessment Methods

Adverse effect (AE): type, severity, management and outcome.

Systematic AE: any systematic sign, symptom, disease, laboratory test result, radiographic finding, or physiologic observation that occurred or worsened after treatment, regardless of causality.

Local AE: including inflammation, infection (any suspected or confirmed superficial or deep infection involving soft tissue or bone, with or without bacteriologic confirmation), hardware failure, pain (new or increased), peripheral edema, heterotopic ossification/soft-tissue calcification, and complications related to wound-healing.

Efficacy Assessment Methods

The primary and secondary efficacy outcomes will be analyzed based on Full Analysis Set (FAS) and Per Protocol (PP) population. The primary analysis will be conducted on the FAS population.

The primary efficacy endpoint is the proportion of subjects who received secondary intervention within 30 weeks after definitive wound closure. The primary analysis will be conducted on the FAS population using Cochran-Armitage trend test to indicate the linear trend in response rates with increasing homodimeric protein dosages. A supportive analysis using the PP population will be performed for the primary efficacy endpoint.

In addition, the secondary efficacy endpoints will be analyzed or summarized as below:

The proportion of subjects with clinical fracture healing and the proportion of subjects with radiographic healing within 30 weeks after definitive wound closure will be compared separately using Cochran-Armitage trend test to indicate the linear trend in response rates with increasing homodimeric protein dosages.

The assessment of time from definitive wound closure to secondary intervention, time from definitive wound closure to clinical fracture healing and time from definitive wound closure to radiographic healing will be summarized separately by group using descriptive statistics (Mean, SD).

The proportion of subjects who received secondary intervention, the proportion of subjects with clinical fracture healing and the proportion of subjects with radiographic healing within postoperative Week 6, Week 12, Week 18, Week 24, Week 42 and Week 52 after definitive wound closure will be summarized separately by group using descriptive statistics (n, %). If applicable, 95% CI of each group will be calculated based on Clopper-Pearson exact CI method for a single binomial proportion.

Study Design 2

A Randomized, evaluator-blind, controlled study to evaluate the safety and efficacy of three dosage levels of homodimeric protein (Hp) including the recombinant polypeptide produced according to Example 6 (i.e., SEQ ID NO: 260)/β-TCP in combination with the cage and posterior supplemental fixation in patients with single level (between L1 to S1) degenerative disk disease (DDD) using posterior open approach for lumbar interbody fusion. Subjects of 24 will be randomly assigned (1:1:1:1) to 4 groups (1 control group and 3 different dose groups), and the clinical study investigational device for treatment of each group are below:

Control group (6 subjects): standard of care (posterior open approach for lumbar interbody fusion with cage) plus either autogenous bone graft implantation (with or without β-TCP);

1 mg Hp/site (6 subjects): standard of care plus 1 mg homodimeric protein per site;

2 mg Hp/site (6 subjects): standard of care plus 2 mg homodimeric protein per site; and

3 mg Hp/site (6 subjects): standard of care plus 3 mg homodimeric protein per site.

Homodimeric protein will be supplied as 5.5 mg Hp/vial lyophilized powder with water for injections. After reconstitution, the homodimeric protein will be mixed with the β-TCP, with the final concentration of 1 mg, 2 mg or 3 mg Hp/site. Then certain amount of the mixture will be applied into the cage, which was determined by the size of cage used.

Homodimeric protein will be reconstituted (the exact volume of water used to get the intended concentration will be stated in Table 18) in three different concentration stock solutions and every 0.24 ml from each stock solution is required to mixed with block β-TCP (0.3 g) in the polyetheretherketone (PEEK) cage (Wiltrom Co., Ltd./xxx series).

The final concentration of homodimeric protein applied at DDD site is: 1.0; 2.0; 3.0 mg Hp/site.

Stock solution of homodimeric protein: 5.5 (mg)/1.32 (ml)=4.2 (mg/ml);

Final concentration of homodimeric protein (mg)/site: 4.2 (mg/ml)×0.24 (ml)=1.0 mg

TABLE 18 Final Concentration Concen- Volume β-TCP Applied Hp/ Hp WFI tration required required (Hp (mg)/ site (mg/vial) (mL) (mg/mL) (mL) (g) β-TCP (g)) (mg) 5.5 1.32 4.2 0.24 0.3 3.3 1.0 5.5 0.65 8.4 0.24 0.3 6.7 2.0 5.5 0.44 12.5 0.24 0.3 10.0 3.0

The source of autograft can be posterior superior iliac spine (PSIS) or bone chips obtained from posterior laminectomy. Autograft can be mixed with β-TCP if the amount of autograft is insufficient. Unilateral or bilateral posterolateral fusion (can be one or two sides) with local graft and posterior supplemental fixation measures can be used in all groups based on investigator's judgment. Intravenous vancomycin (500 mg every 6 hours) will be given prior to operation and for 3 consecutive days.

Subjects will be followed for efficacy and safety for the main study period of 24 weeks and an extension safety follow-up to 24 months after index surgery. In some embodiments, clinical investigators and an independent evaluator will assess the efficacy by evaluating the radiographic results during the trial.

Inclusion Criteria:

Subjects will be included if ALL of the following inclusion criteria apply:

The subject is ≥20 years old;

With single level DDD from L1 to S1 as noted by back pain of discogenic origin, with or without radiculopathy secondary to nerve root compression, manifested by, history of radiating leg or buttock pain, paresthesias, numbness or weakness, or history of neurogenic claudication;

Has radiographic evidence of advanced degenerative lumbosacral disease, such as decreased disk height; herniated nucleus pulposus; hypertrophy or thickening of the ligamentum flavum, annulus fibrosis, or facet joint capsule; hypertrophied facet joints, facet joint space narrowing, or facet periarticular osteophyte formation; trefoil canal shape; or lateral (subarticular) stenosis; or vertebral endplate osteophyte formation; and at least one of the following:

Sagittal plane translation (slippage) of the superior (cranial) vertebral body anterior or posterior to the inferior (caudal) vertebral body is greater than 4 mm or angulation is greater than 10°, or Coronal plane translation (slippage) of the superior (cranial) vertebral body lateral to the inferior (caudal) vertebral body is greater than 4 mm, or narrowing (stenosis) of the lumbar spinal canal and/or intervertebral foramen;

Non responsive to non-operative treatment for at least 6 months;

Females of non-childbearing potential or who have a negative result on pregnancy test within 72 hours prior to surgery, or males;

Female subjects of childbearing potential (i.e., women who have not been surgically sterilized or have not been post-menopausal for at least 1 year) and male subject's partners of childbearing potential must agree to use medically acceptable contraception methods throughout the study period. Medically acceptable contraception methods include hormonal patch, implant or injection intrauterine device, or double barrier method (condom with foam or vaginal spermicidal suppository, diaphragm with spermicidal). Complete abstinence can be considered an acceptable contraception method. Oral contraceptive is an acceptable contraception method prior to the study, but an alternative method will be required during the study;

If female, subject is not breast-feeding;

Willing to provide signed informed consent form (ICF) prior to participation in any study-related procedures and adhere to the study requirements for the length of the trial.

Exclusion Criteria:

Subjects will be excluded if ANY of the following exclusion criteria apply:

Greater than Grade 1 spondylolisthesis (Meyerding's classification, refer to Appendix 1);

Spinal instrumentation implantation or interbody fusion procedure history at the involved level or vertebral body fracture at the planned pedicle screw insertion level;

Established osteomalacia;

Active malignancy or prior malignancy history in past 5 years (except cured cutaneous basal cell carcinoma and cervical carcinoma in situ);

Active local or systemic infection;

Gross obesity, defined as BMI≥30;

Fever>38° C.;

Mentally incompetent. If questionable, obtain psychiatric consult;

Waddell Signs of Inorganic Behavior ≥3 (refer to Appendix 2);

Alcohol or drug abuse, as defined by currently undergoing treatment for alcohol and/or drug abuse. Alcohol abuse is a pattern of drinking that results in harm to one's health, interpersonal relationships, or ability to work;

Autoimmune disease (e.g. Systemic Lupus Erythematosus or dermatomyositis);

Hypersensitivity to protein pharmaceuticals (monoclonal antibodies or gamma globulins);

Previous exposure to rhBMP-2;

Endocrine or metabolic disorders affecting osteogenesis (e.g., hypo- or hyper-thyroidism or parathyroidism, renal osteodystrophy, Ehlers-Danlos syndrome, or osteogenesis imperfecta);

Treatment for 7 days or more with prednisone [cumulative dose>150 mg within 6 months or other steroids with equivalent dose (refer to Appendix 3)], calcitonin (within 6 months). Treatment of Bisphosphonates (for 30 days or more within 12 months), therapeutic doses of fluoride (for 30 days within 12 months), and anti-neoplastic, immunostimulating or immunosuppressive agents within 30 days prior to implantation of the assigned treatment;

Treatment with any investigational therapy within 28 days of implantation surgery;

Has scoliosis greater than 30 degrees;

Subjects have the history or clinical manifestations of significant CNS, cardiovascular, pulmonary, hepatic, renal, metabolic, gastrointestinal, urological, endocrine or hematological disease;

Has a medical disease or condition that would preclude accurate clinical evaluation of the safety and effectiveness of the treatments in this study, such as motor weakness, sensory loss, or painful conditions that inhibit normal ambulation or other activities of daily living;

Has abnormal renal and/or hepatic functions, with Creatinine or ALT or AST value>5 times the upper normal limit;

Has a documented allergy or intolerance to PEEK;

History of hypersensitivity or allergy to Vancomycin;

Any condition that it is not suitable for subjects to participate in the study based on the physician's judgement.

Planned Study Duration:

Screening period: 14 days. Ensure the subject has signed the ICF and assess whether the subject is eligible for the study. The assessments include physical examination, vital signs, electrocardiogram, blood or urine pregnancy test, laboratory examination, pre-operative clinical and radiology evaluation. The data of demography, medical history, concomitant medication and adverse events should be collected.

Treatment period: 1 day. Check whether the subject is eligible for the study, obtain the baseline sample/data and administrate the investigational products. The assessments include physical examination, vital signs and radiology examination. The data of operation information, concomitant medication and adverse events should be collected.

Follow-up period: Subjects will be followed for the main study period of 24 weeks and an extension safety follow-up to 24 months after the implantation. Perform the assessments at Week 6, Week 12, Week 18, Week 24, Month 12, Month 18, Month 24 after treatment. The assessments include concomitant treatments, physical examination, laboratory evaluations, vital signs and radiographic examination (anterior/posterior and lateral views, flexion/extension films). High resolution thin-slice CT scans (1 mm slices with 1 mm index on axial sagittal and coronal reconstructions) will be performed at Week 24 and Month 24.

Assessments of Efficacy Primary Endpoint:

The primary study efficacy endpoint is the proportion of subjects having fusion success at postoperative Week 24.

Secondary Endpoints:

The proportion of subjects having fusion success at postoperative Month 12, Month 18, and Month 24.

Time from baseline to radiographic fusion.

The proportion of subjects who have additional surgical procedures/interventions within postoperative Week 24, Month 12, Month 18 and Month 24; the operation time (from skin incision to wound closure), blood loss (during the operation) and hospital stay will be recorded.

Success rate of Oswestry Disability Index (ODI, refer to Appendix 4) at postoperative Week 24, Month 12, Month 18 and Month 24; ODI Questionnaire was used to assess patient back function. The ODI score ranges from 0-100. The best score is 0 (no disability) and the worst is 100 (maximum disability). Success rate of ODI is reported as percent of subjects whose ODI score met: pre-operative score−post-operative score≥15.

Success rate of improvement in Visual Analogous Scale (VAS, refer to Appendix 5) at postoperative Week 24, Month 12, Month 18 and Month 24. Success rate of back pain is reported as percent of subjects whose improvement in back pain met: pre-operative score−post-operative score>0. Success rate of leg pain is reported as percent of subjects whose improvement in leg pain met: pre-operative score−post-operative score>0.

Efficacy Analyses

The primary and secondary efficacy outcomes will be analyzed based on Full Analysis Set (FAS) and Per Protocol (PP) population. The primary analysis will be conducted on the FAS population.

The primary study efficacy endpoint is the proportion of subjects having fusion success at postoperative Week 24. The primary analysis will be conducted on the FAS population by using Cochran-Armitage trend test to indicate the linear trend in response rates with increasing homodimeric protein dosages. A supportive analysis for the PP population will be performed for the primary efficacy endpoint.

In addition, the secondary efficacy endpoints will be analyzed or summarized as below:

The proportion of subjects having fusion success at postoperative Month 12, Month 18, Month 24 and the proportion of subjects who have additional surgical procedures/interventions within postoperative Week 24, Month 12, Month 18 and Month 24 will be compared separately by using Cochran-Armitage trend test to indicate the linear trend in response rates with increasing homodimeric protein dosages.

The assessment of time from baseline to radiographic fusion will be summarized by group using descriptive statistics (Mean, SD).

The assessment of operation time (from skin incision to wound closure), blood loss (during the operation) and hospital stay will be summarized separately by arm using descriptive statistics (Mean, SD).

Success rate of ODI at postoperative Week 24, Month 12, Month 18 and Month 24 and success rate of VAS at postoperative Week 24, Month 12, Month 18 and Month 24 will be summarized separately by arm using descriptive statistics (n, %). If applicable, 95% CI of each arm will be calculated based on Clopper-Pearson exact CI method for a single binomial proportion.

The disclosure is not to be limited in scope by the specific embodiments described herein. Indeed, various modifications of the disclosure in addition to those described will become apparent to those skilled in the art from the foregoing description and accompanying figures. Such modifications are intended to fall within the scope of the appended claims.

Other embodiments are within the following claims. 

What is claimed is:
 1. A recombinant polypeptide comprising: a first domain selected from the group consisting of SEQ ID NO: 35 and SEQ ID NO: 39; a second domain selected from the group consisting of SEQ ID NO: 47 and SEQ ID NO: 49; and a third domain selected from the group consisting of SEQ ID NO: 57 and SEQ ID NO: 61; wherein the first domain is fused to either C-terminal or N-terminal of the second domain, the third domain is fused to the second domain, the first domain or both of the first and the second domains, and wherein the recombinant polypeptide is capable of inducing alkaline phosphatase activity.
 2. The recombinant polypeptide of claim 1, wherein the first domain is located C-terminal to the second domain, the third domain is located N-terminal to the second domain, or the first domain is located N-terminal to the third domain.
 3. The recombinant polypeptide of claim 1, wherein the second domain comprises an intramolecular disulfide bond.
 4. The recombinant polypeptide of claim 1, wherein the second domain comprises an intramolecular disulfide bond between the twenty-third amino acid of the second domain and the twenty-seventh amino acid of the second domain.
 5. The recombinant polypeptide of claim 1, wherein the third domain comprises a first amino acid sequence of PKACCVPTE (SEQ ID NO: 356) and a second amino acid sequence of GCGCR (SEQ ID NO: 357), and wherein the third domain comprises two intramolecular disulfide bonds between the first and second amino acid sequences.
 6. The recombinant polypeptide of claim 5, wherein the recombinant polypeptide comprises: (a) a first intramolecular disulfide bond between the fourth amino acid of the first amino acid sequence and the second amino acid of the second amino acid sequence, and a second intramolecular disulfide bond between the fifth amino acid of the first amino acid sequence and the fourth amino acid of the second amino acid sequence, or (b) a first intramolecular disulfide bond between the fifth amino acid of the first amino acid sequence and the second amino acid of the second amino acid sequence, and a second intramolecular disulfide bond between the fourth amino acid of the first amino acid sequence and the fourth amino acid of the second amino acid sequence.
 7. A recombinant polypeptide comprises an amino acid sequence selected from the group consisting of: SEQ ID NO: 260, SEQ ID NO: 268, SEQ ID NO: 276, SEQ ID NO: 284, SEQ ID NO: 292, SEQ ID NO: 300, SEQ ID NO: 308, SEQ ID NO: 316, SEQ ID NO: 324, SEQ ID NO: 332, SEQ ID NO: 340, and SEQ ID NO: 348, wherein the recombinant polypeptide is capable of inducing alkaline phosphatase activity.
 8. A homodimeric protein, comprising: two identical recombinant polypeptides of claim 1, wherein the homodimeric protein comprises an intermolecular disulfide bond between the first domains of the two recombinant polypeptides.
 9. The homodimeric protein of claim 8, wherein the homodimeric protein comprises an intermolecular disulfide bond between the fifteenth amino acid in the first domain of one recombinant polypeptide and the fifteenth amino acid in the first domain of the other recombinant polypeptide.
 10. The homodimeric protein of claim 8, wherein the third domain of each recombinant polypeptide comprises a first amino acid sequence of PKACCVPTE (SEQ ID NO: 356) and a second amino acid sequence of GCGCR (SEQ ID NO: 357), and wherein the homodimeric protein comprises two intermolecular disulfide bonds between the first amino acid sequence in the third domain of one recombinant polypeptide and the second amino acid sequence in the third domain of the other recombinant polypeptide.
 11. The homodimeric protein of claim 10, wherein the homodimeric protein comprises: (a) a first intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the other recombinant polypeptide, and a second intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the other recombinant polypeptide, or (b) a first intermolecular disulfide bond between the fifth amino acid of the first amino acid sequence of the one recombinant polypeptide and the second amino acid of the second amino acid sequence of the other recombinant polypeptide, and a second intermolecular disulfide bond between the fourth amino acid of the first amino acid sequence of the one recombinant polypeptide and the fourth amino acid of the second amino acid sequence of the other recombinant polypeptide.
 12. A biodegradable composition capable of inducing bone growth to form a bone mass in a location, comprising: a homodimeric protein of claim 8; and a biodegradable calcium phosphate carrier having a plurality of pores, wherein the homodimeric protein is about 0.003-0.32% (w/w).
 13. The biodegradable composition of claim 12, wherein a porosity of the biodegradable calcium phosphate carrier is larger than 70% with pore size from about 300 μm to about 600 μm.
 14. The biodegradable composition of claim 12, wherein the biodegradable calcium phosphate carrier with pores that extend throughout the biodegradable calcium phosphate carrier, wherein the homodimeric protein is in an effective amount of from about 0.03 mg/g to about 3.2 mg/g of the biodegradable calcium phosphate carrier.
 15. The biodegradable composition of claim 12, wherein the biodegradable composition is suitable for augmentation of a tissue selected from nasal furrows, frown lines, midfacial tissue, jaw-line, chin, and cheeks.
 16. The biodegradable composition of claim 12, wherein the location is selected from the groups consisting of a long-bone fracture defect, a space between two adjacent vertebra bodies, a non-union bone defect, maxilla osteotomy incision, mandible osteotomy incision, sagittal split osteotomy incision, genioplasty osteotomy incision, rapid palatal expansion osteotomy incision, and a space extending lengthwise between two adjacent transverse processes of two adjacent vertebrae.
 17. The biodegradable composition of claim 12, wherein a single dose of the homodimeric protein is from about 0.006 mg to about 15 mg.
 18. The biodegradable composition of claim 12, wherein the biodegradable calcium phosphate carrier hardens so as to be impermeable to efflux of the homodimeric protein in vivo sufficiently that the formed bone mass is confined to a volume of the biodegradable calcium phosphate carrier. 